P0382 - Gastric Outlet Obstruction as a Complication of Replaced Gastrostomy Tube

Presenting Author(s)

• 

  David Wan, MD

  Assistant Professor of Medicine
  New York-Presbyterian/Weill Cornell Medical Center
  New York, New York

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.

References:

- Kurien M, McAlindon ME, Westaby D, et al. Percutaneous endoscopic gastrostomy (PEG) feeding. BMJ. 2010;340:c2414.

- Juern J, Verhaalen A. Videos in clinical medicine. Gastrostomy-tube exchange. N Engl J Med. 2014;370:e28.

- Khoury T, Daher S, Yaari S, et al. To Pull or to Scope: A Prospective Safety and Cost-effectiveness of Percutaneous Endoscopic Gastrostomy Tube Replacement Methods. J Clin Gastroenterol. 2019 Jan;53(1):e37-e40.

- Showalter CD, Kerrey B, Spellman-Kennebeck S, Timm N. Gastrostomy tube replacement in a pediatric ED: frequency of complications and impact of confirmatory imaging. Am J Emerg Med. 2012;30:1501–1506.

Disclosures:

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.