External bolster placement after percutaneous endoscopic gastrostomy tube insertion: is looser better?

Abdominal and gastric wall inflammation, infection, and necrosis after percutaneous endoscopic gastrostomy (PEG) placement is a topic of importance but of limited study. Healing of the abdominal wound after PEG placement is thought to be dependent on a number of factors, including the patient's nutrition status, comorbid disease status, and postprocedural PEG wound care. Another important factor that may influence wound healing is tissue tension and compression. This requires special attention to the correct placement of the external bolster of the PEG tube against the abdominal wall.

We performed a study in mongrel dogs to determine the relevance of tissue compression on PEG-tube wound healing; 8 mongrel dogs each received 3 separate 24 Fr PEG tubes at 1 endoscopic setting. After PEG placement, the external bolster was placed at 0 cm, 1 cm, or 4 cm from the abdominal wall. Post-PEG care and enteral feedings were standardized. The dogs were killed at 3 weeks.

Partial migration of the PEG internal bolster into the gastric wall occurred in 1 of 8 of the PEG tubes with the external bolster at 0 cm. PEG-tube-tract tissue inflammation was worse in the dogs with the external bolster placed at 0 cm.

The position of the external bolster in relation to the abdominal wall may be an important factor in the healing of a post-PEG-tube-placement tissue tract.