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Endoscopic rescue of early percutaneous endoscopy gastrostomy tube dislodgement

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Abstract

Background

Percutaneous endoscopic gastrostomy (PEG) tube placement is one of the most common methods for establishing durable enteral access. Early PEG dislodgement occurs in < 5% of cases but typically prompts urgent surgical intervention to reestablish the gastrocutaneous tract and prevent intra-abdominal sepsis. To date, there is a single case report in the literature where successful endoscopic “rescue” of an early dislodged PEG tube negated the need for operative intervention. Here, we report our experience with a series of endoscopic PEG rescues for early dislodged PEG tubes.

Methods

A retrospective analysis of cases was reviewed from two institutions. Patients with early PEG dislodgements underwent PEG rescue using a gastroscope and standard Ponsky “Pull” PEG techniques through the original tract.

Results

Eleven patients were identified from the database and underwent PEG rescue after early PEG dislodgement. Mean operative time was 68 min, and there were no complications related to PEG rescue. PEG rescue permitted safe re-establishment of the gastrostomy tract while avoiding laparoscopic or open surgical intervention in hemodynamically stable patients. All patients tolerated the procedure well and were able to resume use of the PEG tubes shortly after intervention.

Conclusion

Endoscopic rescue represents a feasible noninvasive option for PEG tube replacement following early inadvertent PEG tube dislodgement in appropriate clinical settings.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA

    R. M. Juza, S. Drexel & J. M. Marks

  2. Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA

    S. Docimo

  3. Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA

    E. M. Pauli

Authors
  1. R. M. Juza
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  2. S. Docimo
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  3. S. Drexel
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  4. V. Sandoval
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  5. J. M. Marks
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  6. E. M. Pauli
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Correspondence to R. M. Juza.

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Disclosures

Dr. Salvatore Docimo is a consultant for Boston Scientific. Dr. Jeffrey M. Marks is a paid consultant for Boston Scientific and Olympus. Dr. Eric M. Pauli is a paid consultant for Bard, Cook, Boston Scientific, Baxter, and OVESCO. He receives royalty feeds from UpToDate and Springer. He receives consulting fees from Actuated Medical. Dr. Ryan M. Juza, Dr. Sabrina Drexel, Dr. Victor Sandoval have no conflict of interest.

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Juza, R.M., Docimo, S., Drexel, S. et al. Endoscopic rescue of early percutaneous endoscopy gastrostomy tube dislodgement. Surg Endosc 35, 1915–1920 (2021). https://doi.org/10.1007/s00464-020-08203-1

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  • DOI: https://doi.org/10.1007/s00464-020-08203-1

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