Related Experiment Videos
Complications of retained internal bolster after pediatric percutaneous endoscopic gastrostomy
D L Mollitt1, M L Dokler, J S Evans
1Department of Surgery, University of Florida Health Science Center, Jacksonville 32209, USA.
Insights
Retained internal bolsters after pediatric percutaneous endoscopic gastrostomy (PEG) removal can cause serious complications like esophageal obstruction and gastric outlet issues. Close monitoring for spontaneous passage is crucial to prevent adverse outcomes.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Procedures
- Surgical Complications
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a common method for nutritional support in children.
- The Gauderer-Ponsky tube with internal and external SILASTIC bolsters is frequently used for PEG placement.
- Complications typically arise during PEG insertion, but issues with tube removal are less documented.
Purpose of the Study:
- To describe a less-recognized complication associated with the removal of pediatric PEG tubes.
- To highlight the potential sequelae of retained internal bolsters after PEG tube removal in children.
Main Methods:
- A review of 234 pediatric PEG procedures performed using the Gauderer-Ponsky tube between 1992 and the study period.
- Standard practice involved removing PEG tubes around 6 weeks post-procedure and replacing them with gastric buttons, with the internal bolster intended for spontaneous passage.
- Analysis of cases where the internal bolster failed to pass spontaneously.
Main Results:
- Five children (2.1%) experienced failure of the internal bolster to pass spontaneously after PEG removal.
- Three children developed dysphagia and drooling due to the bolster lodging in the esophagus, requiring endoscopic removal and resulting in esophageal strictures (two needing dilation, one stricturoplasty).
- One child presented with intermittent gastric outlet obstruction due to a retained bolster, resolved by endoscopic retrieval; another had an asymptomatic retained bolster.
Conclusions:
- The spontaneous passage of the internal bolster after pediatric PEG removal is not always successful and can lead to significant complications.
- Retained bolsters can cause esophageal obstruction and gastric outlet issues, necessitating medical intervention.
- Altered follow-up protocols are recommended to monitor for prompt bolster passage after PEG tube removal in pediatric patients.
Purpose:
Percutaneous endoscopic gastrostomy (PEG) has been widely accepted as an efficacious means of nutritional support in the infant and child. A well-described technique uses the Gauderer-Ponsky tube (CR Bard Incorporated, Tewksbury, MA) drawn antegrade through the gastric wall and secured by an internal and external SILASTIC (Dow Corning; Midland, MI) bolster. The majority of reported complications attendant to its use occur secondary to insertion. This report details a less well-described complication of tube removal.
Methods:
Since 1992, 234 pediatric PEGs have been performed using a Gauderer-Ponsky tube. Approximately 6 weeks after the procedure, all catheters were removed and replaced with gastric buttons. The internal bolster was left within the stomach to pass spontaneously.
Results:
Five children (2.1%), ages 6 months to 5 years, failed to pass this crossbar. Three subsequently presented with dysphagia and drooling with the internal bolster wedged in the proximal esophagus. All were left with significant residual stricture after endoscopic removal of the crossbar. Two required dilatation and the third underwent operative stricturoplasty. A fourth child returned with intermittent gastric outlet obstruction. The internal bolster was retained in the stomach 4 months after catheter removal. Endoscopic retrieval resulted in resolution of the symptomatology. The final case was found to have an asymptomatic bolster in the stomach approximately 18 months after catheter removal.
Conclusions:
These cases highlight a potential sequelae of pediatric percutaneous endoscopic gastrostomy not previously acknowledged. The significant complications associated with the retained bolster in four of these five children suggests that follow-up should be altered to monitor prompt passage of the crossbar after tube removal.