Management of PEG tube site erosion with NPWT

Tuong Nguyen, MD, Samudra Sanyal, Efrain Aguilar, Jay Strain, Pak Leung, Mark Kaplan. Einstein medical center

Abstract: Background: Percutaneous endoscopic gastrostomy (PEG) tube has been in use for over 30 years with increased in rate of utilization.  However, placement of PEG tube is associated with variety of complications.  Several studies have reported complications ranging from 4 to 23.8% of the cases.  Erosion of the PEG tube site is a rare complication and currently there are no literatures on non-operative management of this complication.

Method: Here we present a case of severe erosion of anterior abdominal wall at the PEG tube site from a gastrocutaneous (GC) fistula managed successfully with negative pressure wound therapy (NPWT) after failure of conventional therapy.  The NPWT dressing consists of white sponge over the ulcer, Adaptic non-adhesive dressing over the white sponge and then black sponge on top.  This dressing was changed three times a week.

Result: NPWT is an excellent way to control leaking of gastric content around the catheter.  Another benefit of NPWT is its ability to promote wound healing.  There was marketed shrinkage of the ulcer after only 2 dressing changes.  After 2 weeks of NPWT the wound improved significantly and shrink to a circular lesion of less than 2cm in diameter.  We planned to continue NPWT until the wound continues to shrink and heal or to a point where we can perform skin graft

Conclusion: This is the first case to report the use of negative wound therapy to manage severe erosion of PEG tube site.  Current standard of care for this complication involves removal of the gastrostomy tube to allow healing and insertion of new gastrostomy tube at a new site.  While there have been several endoscopic or percutaneous methods described in the literature to close the GC fistulas secondary to PEG tubes, operative management remains the current standard of care.  NPWT is a novel technique to deal with this complication in patients who are not surgical candidates or who cannot go without enteral access for nutrition.

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