The management of complications of Foley feeding gastrostomies

The recent modification of the Ponsky technique of percutaneous endoscopic gastrostomy places a Foley catheter in the stomach instead of a mushroom catheter. Experience with four patients with long term Foley feeding gastrostomies revealed two types of complications that occurred 23 times, a) the rupture of the balloon fourteen times allowing the catheter to slip out and b) distal migration of the balloon causing intestinal obstruction nine times. Since long term feeding gastrostomies using a Foley catheter will continue to be used and probably increase with the recent modifications of the PEG it is essential that physicians and emergency room personnel be informed of those two complications. If and when either rupture of the balloon or distal migration occur, the Foley should be replaced with a mushroom catheter. Once the gastrocutaneous fistula is mature, usually after 2 weeks, it is safe to insert a mushroom catheter, which is not subject to those complications.