Management of early PEG tube dislodgement: simultaneous endoscopic closure of gastric wall defect and PEG replacement

A 53-year-old man with dysphagia underwent uneventful placement of a percutaneous endoscopic gastrostomy (PEG) tube for long-term enteral feeding access. 11 hours after the procedure, it was discovered that he had accidentally dislodged the feeding tube. On physical examination, he was found to have a benign abdomen without evidence of peritonitis or sepsis. He was observed overnight with serial abdominal examinations and nasogastric decompression. In the morning, he was taken back to the endoscopy suite where endoscopic clips were employed to close the gastric wall defect and a PEG tube was replaced at an adjacent site. The patient was fed 24 hours thereafter and discharged from the hospital 48 hours after the procedure. Early accidental removal of a PEG tube in patients without sepsis or peritonitis can be safely treated with simultaneous endoscopic closure of the gastrotomy and PEG tube replacement, resulting in earlier enteral feeding and shorter hospital stay.

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Buried Bumper Syndrome Revisited: A Rare but Potentially Fatal Complication of PEG Tube Placement

Case Reports in Critical Care ◽

10.1155/2014/634953 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Saptarshi Biswas ◽

Sujana Dontukurthy ◽

Mathew G. Rosenzweig ◽

Ravi Kothuru ◽

Sunil Abrol

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Gastric Wall ◽

Late Complications ◽

Tube Placement ◽

Endoscopic Gastrostomy ◽

Enteral Access ◽

Delayed Complications ◽

Buried Bumper Syndrome ◽

Peg Tube

Percutaneous endoscopic gastrostomy (PEG) has been used for providing enteral access to patients who require long-term enteral nutrition for years. Although generally considered safe, PEG tube placement can be associated with many immediate and delayed complications. Buried bumper syndrome (BBS) is one of the uncommon and late complications of percutaneous endoscopic gastrostomy (PEG) placement. It occurs when the internal bumper of the PEG tube erodes into the gastric wall and lodges itself between the gastric wall and skin. This can lead to a variety of additional complications such as wound infection, peritonitis, and necrotizing fasciitis. We present here a case of buried bumper syndrome which caused extensive necrosis of the anterior abdominal wall.

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The Buried Bumper Syndrome: External Bumper Extraction after Radial Mini Incisions and Replacement through an Adjacent Tract

Case Reports in Medicine ◽

10.1155/2016/5379291 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

M. A. Benatta

Keyword(s):

Nutritional Support ◽

Laparoscopic Treatment ◽

Abdominal Ct ◽

Endoscopic Gastrostomy ◽

Threatening Condition ◽

Life Threatening ◽

Adjacent Site ◽

Buried Bumper Syndrome ◽

Peg Tube

Although considered as a safe method to provide long-term nutritional support, percutaneous endoscopic gastrostomy (PEG) may be complicated by a buried bumper syndrome (BBS), a life-threatening condition. Removal of the PEG tube with its buried bumper and reinsertion of a new PEG tube is often necessary. Since its description in 1988, less than 50 cases of BBS managed by external extraction of the buried bumper have been reported. We report a case of buried bumper that was removed by external traction without the need for endoscopic or laparoscopic treatment but with the need of two radial millimeter skin incisions after abdominal CT study and finally immediate PEG replacement but through an adjacent site.

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Direct percutaneous endoscopic jejunostomy performed with gastroscope

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.129986 ◽

2013 ◽

Vol 04 (03) ◽

pp. 090-092

Author(s):

Ajay P. Choksi ◽

Keyur C. Shah ◽

Harshad K. Parekh

Keyword(s):

Small Bowel ◽

Percutaneous Endoscopic Gastrostomy ◽

Enteral Feeding ◽

Nutritional Support ◽

Feeding Tube ◽

Endoscopic Gastrostomy ◽

Gastric Feeding ◽

Endoscopic Placement ◽

Percutaneous Endoscopic Jejunostomy

AbstractWhile percutaneous endoscopic gastrostomy (PEG) is a well-known approach for achieving enteral feeding, direct percutaneous endoscopic jejunostomy (DPEJ) is a technique that allows endoscopic placement of percutaneous/transabdominal feeding tube directly into the jejunum. It offers a non-surgical alternative for postpyloric enteral feeding for long-term nutritional support when gastric feeding is not technically possible or is inappriopriate. Conventionally DPEJ is done with pediatric colonoscope or small bowel enteroscope. Here, we report a case where DPEJ was accomplished with gastroscope.

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Randomized Prospective Comparison of Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Feeding Tube Placement Versus Percutaneous Endoscopic Gastrostomy Feeding Tube Placement with Jejunal Extension (PEG-J), for Enteral Feeding

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2006.03.320 ◽

2006 ◽

Vol 63 (5) ◽

pp. AB160 ◽

Cited By ~ 6

Author(s):

Mark Delegge ◽

Greg Buck ◽

John Fang ◽

James Disario ◽

Glen Lehman ◽

...

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Enteral Feeding ◽

Feeding Tube ◽

Tube Placement ◽

Endoscopic Gastrostomy ◽

Prospective Comparison ◽

Percutaneous Endoscopic Jejunostomy ◽

Feeding Tube Placement

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Percutaneous endoscopic gastrostomy to set up a long-term enteral feeding route in children: an encouraging result

Pediatric Surgery International ◽

10.1007/s00383-002-0933-x ◽

2003 ◽

Vol 19 (4) ◽

pp. 283-285 ◽

Cited By ~ 9

Author(s):

Pi-Feng Chang ◽

Yen-Hsuan Ni ◽

Mei-Hwei Chang

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Enteral Feeding ◽

Endoscopic Gastrostomy ◽

Set Up

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SURGICAL GASTROSTOMY BASED ON ENDOSCOPIC CONCEPTS

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201600010013 ◽

2016 ◽

Vol 29 (1) ◽

pp. 50-52

Author(s):

Emmanuel Conrado SOUZA

Keyword(s):

Gastric Wall ◽

Percutaneous Approach ◽

Endoscopic Gastrostomy ◽

Minimal Incision ◽

Left Hypochondrium ◽

Direct View ◽

Anterior Gastric Wall ◽

Enteral Access ◽

Surgical Gastrostomy

Background: Until the early 1980s, Stamm technique was considered standard method to gastrostomy. After description of the endoscopic technique, due to its efficiency and speed, quickly became the method of choice for long-term enteral access. Aim: Describe a technique that combines direct view of the stomach from open surgery with the simplicity and less traumatic endoscopic gastrostomy method. Method: In patient supine under spinal anesthesia the technique stars with small epigastric incision to pull up the stomach. A 3 mm incision in the left hypochondrium is made to pass needle puncture to guidewire passage. The stomach is drilled, guidewire is seizured, connection to catheter and percutaneous approach is made with traction of the stomach to the abdominal wall. Purse suture on the anterior gastric wall is not needed. Results: Twenty-eight patients underwent gastrostomy using endoscopy devices; six had local minor complications without the need for re-intervention; there was no death. Conclusion: The surgical gastrostomy with minimal incision in the stomach to pull off the catheter using endoscopic gastrostomy devices, proved to be safe, easy to perform, less traumatic, quick, simple and elegant.

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Long-Term Survival of Patients Receiving Artificial Nutrition in Japanese Psychiatric Hospitals

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000448242 ◽

2016 ◽

Vol 6 (3) ◽

pp. 477-485 ◽

Cited By ~ 2

Author(s):

Keiichi Abe ◽

Ryuko Yamashita ◽

Keiko Kondo ◽

Keiko Takayama ◽

Osamu Yokota ◽

...

Keyword(s):

Multiple Logistic Regression Analysis ◽

Tube Feeding ◽

Oral Intake ◽

Psychiatric Hospitals ◽

Artificial Nutrition ◽

Term Survival ◽

Long Term Survival ◽

Endoscopic Gastrostomy ◽

Peg Tube

Background/Aims: Most patients with dementia suffer from dysphagia in the terminal stage of the disease. In Japan, most elderly patients with dysphagia receive either tube feeding or total parenteral nutrition. Methods: In this study, we investigated the factors determining longer survival with artificial nutrition. Various clinical characteristics of 168 inpatients receiving artificial nutrition without oral intake in psychiatric hospitals in Okayama Prefecture, Japan, were evaluated. Results: Multiple logistic regression analysis showed that the duration of artificial nutrition was associated with a percutaneous endoscopic gastrostomy (PEG) tube, diagnosis of mental disorder, low MMSE score, and absence of decubitus. Conclusion: Patients with mental disorders survived longer than those with dementia diseases on artificial nutrition. A PEG tube and good nutrition seem to be important for long-term survival.

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An overview of enteral feeding in the community

British Journal of Community Nursing ◽

10.12968/bjcn.2021.26.1.26 ◽

2021 ◽

Vol 26 (1) ◽

pp. 26-29

Author(s):

Sarah Jane Palmer

Keyword(s):

Enteral Feeding ◽

Healthcare Professionals ◽

Social Needs ◽

Care Plan ◽

Medical Attention ◽

Community Settings ◽

Community Based ◽

Basic Principles ◽

Endoscopic Gastrostomy ◽

Peg Tube

Enteral feeding in community settings is becoming increasingly common, and this article aims to help nurses and other healthcare professionals to refresh their knowledge of the important concepts in the community-based care of patients receiving enteral nutrition via a percutaneous endoscopic gastrostomy (PEG) tube. The article provides an overview on the management and care of the patient, the basic principles surrounding the equipment used, identifying the wider team and essential communication to bear in mind, as well as the importance of tailoring a care plan to the individual's needs, taking into consideration cognition, mental health, social needs and other factors. The article also covers red flags that may be seen in the community after tube insertion that require immediate medical attention.

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