Long-term percutaneous endoscopic gastrostomy: characteristic computed tomographic findings

Area of Science:

• Radiology
• Gastroenterology
• Medical Imaging

Background:

• Long-term percutaneous endoscopic gastrostomy (PEG) tubes can lead to complications.
• Physical and endoscopic examinations have limitations in visualizing the tract between the skin and stomach.
• Computed tomography (CT) offers a potential solution for detailed assessment of the PEG tract.

Purpose of the Study:

• To evaluate the utility of CT in assessing complications in patients with long-term PEG.
• To document specific CT findings related to PEG tube sites.
• To compare anatomical measurements along the PEG tract with those distant from it.

Main Methods:

• Retrospective analysis of CT examinations in 57 patients with long-term PEG (over 1 year).
• Recorded CT findings included skin indentation, soft-tissue thickening, peritoneal gap, and internal bumper migration.
• Measured thickness of subcutaneous fat, muscle, and abdominal wall along the PEG tract and at a control site.

Main Results:

• CT identified soft-tissue thickening in 49.1%, skin indentation in 33.3%, and peritoneal gap in 42.1% of patients.
• Specific complications noted: internal bumper migration (1 patient), buried bumper syndrome (3 patients), gastric herniation (2 patients), and metastatic esophageal cancer to the PEG site (1 patient).
• Significant decreases in subcutaneous fat, muscle, and abdominal wall thickness were observed along the PEG tract.

Conclusions:

• CT provides detailed anatomical information and orientation along the PEG tube.
• Familiarity with CT findings can help minimize potential complications before PEG tube replacement.
• CT is a valuable tool for evaluating complications in patients with long-term PEG.