• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Simultaneous Endoscopic Gastrostomy closure and PEG Replacement after Early Accidental Removal

Simultaneous Endoscopic Gastrostomy closure and PEG Replacement after Early Accidental Removal

Matthew Mayuiers, MD, Charles E Lucas, MD, Choichi Sugawa, MD. Wayne State University, Department of Surgery

Introduction: Since 1980, the preferred method of enteral access has been the percutaneous endoscopic gastrostomy tube (PEG). Accidental removal is a common complication associated with excessive cost and possible significant morbidity.

Removal prior to 14 days is considered “early removal.” Early removal has more significant risk associated with it, and can necessitate emergent operation to prevent peritonitis and sepsis. Some patients, who do not exhibit signs of peritonitis, may be simply observed.   For these patients, PEG replacement would typically be delayed 5-10 days to ensure closure. This delay results in prolonged NPO status and worsened nutritional status. Presented below is a case of early accidental removal followed by endoscopic clip closure, and immediate PEG replacement.

Case Report: A 43-year-old male presented after a large left middle cerebral artery infarct. A PEG placement was completed without complication. Eleven hours after the procedure the patient had pulled the PEG tube out of the abdominal wall. At this time the patient appeared to have no abdominal pain and no signs of peritonitis. Twelve hours following the accidental removal of his PEG tube, the patient was taken back to the endoscopy suite, and an EGD was performed.  The previous PEG site was identified and appeared closed and ulcerated. The mucosal defect was closed with two endoscopic metallic clips. A PEG tube was then placed at an adjacent site.

The following day, the patient was restarted on trickle feeds and advanced to regular tube feeding over a period of 24 hours. Since that time, his PEG has been functioning well.

Discussion: We propose that in the case of early accidental PEG removal, the patient should be examined first for evidence of peritonitis. If initial physical exam and radiographic investigation do not reveal peritonitis or significant pneumoperitoneum, the patient should undergo urgent repeat endoscopy. At this time, the gastrotomy can be closed endoscopically via metallic clips and PEG can be replaced immediately.  Tube feeds can be initiated after a 12-24 hour period of dependent drainage with serial abdominal exams.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 85664

Program Number: P376

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

224

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals