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Management of early dislodgment of percutaneous endoscopic gastrostomy tubes
1Department of Surgery, University of South Alabama, Mobile, USA.
Insights
Premature removal of percutaneous endoscopic gastrostomy (PEG) tubes is a serious complication. Nonoperative management is often feasible, with laparoscopy being a safe option if surgery is required for suspected intraperitoneal spillage.
Area of Science:
- Gastroenterology
- Surgical Complications
- Minimally Invasive Surgery
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a common procedure for enteral feeding.
- Premature dislodgement of the PEG tube is a significant complication.
- Optimal management strategies for this complication require clarification.
Purpose of the Study:
- To review the management of premature PEG tube removal.
- To determine the feasibility and outcomes of nonoperative and operative interventions.
- To evaluate the role of laparoscopy in managing complications.
Main Methods:
- Retrospective review of 197 patients who underwent PEG placement.
- Identification of patients with premature PEG tube removal (within 2.9 +/- 1.3 days).
- Analysis of management strategies including nonoperative approaches and surgical interventions.
Main Results:
- Six patients experienced premature PEG tube removal.
- Only one patient required an emergent operation.
- Nonoperative management included immediate tube replacement, observation with repeat PEG, or delayed laparoscopic gastrostomy.
- Laparoscopy provided effective visualization, irrigation, and new enteral access placement.
Conclusions:
- Nonoperative management is a viable option for most patients with premature PEG tube dislodgement.
- Laparoscopy is a safe and effective surgical approach for managing complications like intraperitoneal spillage, avoiding laparotomy morbidity.
- Timely and appropriate management can prevent further complications and ensure continued enteral access.
Abstract:
One of the most serious complications of percutaneous endoscopic gastrostomy (PEG) is premature removal of the gastrostomy tube. In an attempt to clarify the optimal therapy of this complication, the records of 197 patients undergoing PEG were reviewed. Six patients whose PEG tubes were removed 2.9 +/- 1.3 days after placement were identified; only one patient required an emergent operation. The patients managed nonoperatively were treated by immediate replacement of tubes through the tracts (two patients), observation prior to repeat PEG (two), and delayed laparoscopic gastrostomy (one). Nonoperative management is feasible in the majority of patients suffering this complication. When an operation is indicated because of suspected intraperitoneal spillage, laparoscopy allows wide visualization and irrigation of the peritoneal cavity, closure of the gastrotomy, and placement of new enteral access while avoiding the morbidity associated with laparotomy in these often-debilitated patients.