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Venting issues.

Neel Sharma1, Rachel Cooney1, Sheldon C Cooper1

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This summary is machine-generated.

A patient with intestinal failure due to scleroderma underwent a new endoscopic PEG insertion alongside a buried PEG. The decision was made due to high anesthetic risks associated with laparotomy for removal.

Keywords:
artificial nutrition supportendoscopic gastrostomyenteral/parenteral nutritionnutritionnutritional support

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Area of Science:

  • Gastroenterology
  • Rheumatology
  • Surgical Endoscopy

Background:

  • A 65-year-old woman with type 3 intestinal failure secondary to scleroderma of the gut and rheumatoid arthritis.
  • Patient on home parenteral nutrition since 2011, with a history of intractable vomiting due to gut dysmotility and small bowel bacterial overgrowth.
  • Previous endoscopic PEG exchange under sedation was poorly tolerated, necessitating anesthesia.

Purpose of the Study:

  • To review a percutaneous endoscopic gastrostomy (PEG) tube for potential elective replacement.
  • To manage a buried PEG in a patient with high anesthetic risks for surgical intervention.

Main Methods:

  • Endoscopic examination for PEG review.
  • Multidisciplinary team meeting to discuss management options.
  • Endoscopic insertion of a new venting PEG alongside the existing buried PEG.

Main Results:

  • The initial endoscopy was performed for planned PEG review.
  • The anesthetic risk of laparotomy for PEG removal was deemed too high.
  • A new venting PEG was inserted endoscopically, with the plan to remove the old one later.

Conclusions:

  • Endoscopic management can be a viable alternative to surgery in high-risk patients.
  • Multidisciplinary approach is crucial for managing complex gastrointestinal issues in patients with systemic diseases.
  • This case highlights a strategy for managing buried PEG tubes when surgical removal is contraindicated.