Complications of retained internal bolster after pediatric percutaneous endoscopic gastrostomy

A simple adjunct for safer change of PEG

“…A number of complications related to removal of the PEG are recognised [1][2][3][4][5][6]. These have primarily been due to retention within the bowel of components of the PEG, consisting either of remnants of broken tubes or, more commonly, of detachable internal retaining crossbars [2][3][4][5].…”

“…These have primarily been due to retention within the bowel of components of the PEG, consisting either of remnants of broken tubes or, more commonly, of detachable internal retaining crossbars [2][3][4][5]. Indeed, PEGs have been removed by traction, by cutting the tube at the skin level [5] or by using devices assembled with an internal detachable crossbar, which slid off the tube when this was pulled out [1,4].…”

“…A number of complications have been associated with insertion as well as removal or change of PEG to another gastrostomy device [1][2][3][4][5]. Attention must be paid to technical details in order to avoid or treat appropriately such complications [6].…”

Percutaneous Endoscopic Gastrostomy in Neurological Patients

“…Small bowel volvulus around the PEG and subsequent obstruction has also been reported (Alawadhi et al, 1991;Al-Homaidhi & Tolia, 2001;Hoffer et al, 1999). Additionally, loosening of the external bolster can allow migration of the internal bumper through the pylorus into the small bowel, mimicking small bowel obstruction (Hoffer et al, 1999;Mollitt et al, 1998;Schrag et al, 2007). Wound Infection is a common occurrence, with local infection found to occur in up to 23% of cases (Lee et al, 2002).…”

Percutaneous Endoscopic Gastrostomy in Pediatric Patients

“…This is commonly performed in adult practice, but is generally thought to be unacceptable in children due to risks of esophageal and intestinal obstruction. Esophageal obstruction, perforation, mediastinitis, retropharyngeal abscess formation, gastric outlet, intestinal and ileostomy obstruction, enterocutaneous fistula formation, tract disruption and death have been variously described with PEG removal (Yaseen et al, 1996, Siegel and Douglass, 2004, Palmer et al, 2006, Mollitt et al, 1998, Lattuneddu et al, 2003, Kobak et al, 2000, El-Rifai et al, 2004. Traction removal is performed under general anesthesia in children and involves application of a significant pulling force to deliver the device in full.…”