Ryan M Juza, MD1, Salvatore Docimo, MD1, Victor Sandoval, MD2, Jeffrey M Marks, MD, FACS2, Eric M Pauli, MD, FACS1. 1Penn State Hershey Medical Center, 2University Hospitals Case Medical Center
Objective: Percutaneous endoscopic gastrostomy (PEG) tube placement is the standard of care for establishing durable enteral access. Early PEG dislodgement occurs in <5% of cases but usually prompts urgent surgical intervention to reestablish the gastrocutaneous tract and prevent intraabdominal sepsis. To date, there is only a single literature reported case where successful endoscopic “rescue” of early PEG dislodgement negated the need for operative intervention. Here we report our experience with a series of PEG rescues.
Methods and Procedure: A retrospective review of prospectively collected cases was reviewed from two institutions. Patients with dislodged PEGs and hemodynamic instability or peritonitis were excluded from endoscopic intervention and underwent surgical intervention. Stable patients underwent PEG rescue in the operating room under general anesthesia. A diagnostic gastroscope was inserted per os and advanced to the stomach under carbon dioxide insufflation. The previous gastrostomy site was identified on the anterior wall of the stomach and a wire-guided dilating balloon was used to traverse the gastrotomy site with the endoscope. The peritoneal cavity was surveilled and gross contamination irrigated and suctioned. A looped guidewire was placed through the prior cutaneous incision and withdrawn through the gastrotomy tract retrograde and out of the mouth with the aid of an endoscopic snare. A new PEG tube was affixed to the wire and standard Ponsky ‘pull’ technique used to complete PEG replacement. Gastropexy with gastrointestinal T-anchors was performed in the majority of cases.
Results: Eight patients were identified in the databases. Average age was 68 ± 12 years. The most common indication for PEG placement was dysphagia. Early dislodgement occurred between postoperative day 0 and 7 and the average time to PEG rescue was 10 hours post-dislodgement. Operative time averaged 95 minutes and time to reinitiating enteral feeding was 48 hours. There were no complications related to endoscopy or PEG dislodgement. Two patients required subsequent conversion to a trans-gastric jejunal feeding tube for delayed gastric emptying.
Conclusions: PEG dislodgement is an uncommon but well recognized occurrence traditionally requiring urgent surgical intervention. PEG rescue permits safe re-establishment of the gastrostomy tract while avoiding laparoscopic or open surgical intervention in stable patients. In this series, patients tolerated the procedure well and were able to resume feeding shortly after intervention. Endoscopic rescue represents a feasible noninvasive option for PEG tube replacement.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77558
Program Number: P336
Presentation Session: Poster (Non CME)
Presentation Type: Poster
