Trent Walradt1, Tracey Martin, MD2, AnnMarie Kieber-Emmons, MD2, David Wan, MD1
1Weill Cornell Medical College, New York, NY; 2New York-Presbyterian / Weill Cornell Medical Center, New York, NY
Introduction: Percutaneous endoscopic gastrostomy (PEG) is a common procedure for the provision of long term enteral nutrition1. Indications for PEG tube replacement include tube malfunction, dislodgement, or scheduled exchange2. Complications of replacement include bleeding, infection, and tube misplacement3. Gastric outlet obstruction (GOO) is a rare complication seen when the tube is inserted distal to the pylorus or the balloon is overfilled4.
Case Description/Methods: An 86-year-old woman with a history of previous stroke necessitating prolonged enteral feeding through PEG presented to the hospital due to a clogged PEG tube. The tube was replaced at bedside via the percutaneous route and gastric fluid was aspirated. The tube was noted to be 2 cm deeper than prior to the procedure. A water-soluble contrast study through the PEG tube was obtained to confirm proper position (Fig. 1) which showed contrast within the small bowel. The radiologist concluded the gastrostomy tube was in satisfactory position and tube feedings were resumed. Overnight, the patient experienced several episodes dark emesis. An endoscopy the next morning revealed the gastrostomy tube balloon was inflated in the duodenal bulb causing a GOO (Fig. 2). The tube was repositioned in the stomach (Fig. 3) and the patient was discharged 4 days later.
Discussion: This case illustrates the importance of establishing a standardized approach to the confirmation and documentation of PEG tube replacement. The marker on the replacement tube should be close to that of the previous tube. Notably, resistance to traction at a greater depth than expected may represent post-pyloric placement of the balloon. Finally, when imaging is obtained, fluoroscopy should be performed at an oblique angle and contrast should be observed in the stomach to confirm correct placement.
Citation: Trent Walradt; Tracey Martin, MD; AnnMarie Kieber-Emmons, MD; David Wan, MD. P0382 - GASTRIC OUTLET OBSTRUCTION AS A COMPLICATION OF REPLACED GASTROSTOMY TUBE. Program No. P0382. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.