Mechanism of the Development of Gastric Ulcer after Percutaneous Endoscopic Gastrostomy

Abstract

The occurrence of gastric ulcer after PEG placement was attributable to the shape of the PEG tube within the intragastric space, and not to the use of H 2 -blockers, suggesting that appropriate placement of the PEG tube is an important factor in preventing gastric ulcer.

Effect of Percutaneous Endoscopic Gastrostomy Tube Placement on the Outcome of the Fecal Occult Blood Test

“…Forty-three patients were African American, 22 Caucasian and 2 Hispanic. Eighteen patients had life threatening conditions like colon cancer (2), lung cancer with metastasis (2), lung cancer without metastasis (2), prostate cancer (5), pituitary tumor (1), head and neck cancer (5), and esophageal cancer (1). Other co-morbid conditions in our patients were stroke in 12 patients, peptic ulcer disease in 5 patients, dementia in 2 patients, and Huntington's disease in 1 patient.…”

“…However, we believe that even if patients were taking proton pump inhibitors or H2-receptor blockers post PEG tube FOBT would be positive since bleeding is known to occur after PEG tube placement in the first few hours to days likely caused by puncture of mucosal or abdominal wall vessel [15][16][17][18] which would not be affected by proton pump inhibitor treatment. Even if patients were on H2-receptor blocker prior to PEG tube placement, the mechanism of gastric ulcer formation that may cause positive FOBT is mechanical injury of mucosa from PEG tube [5,19] rather than acid injury and conceivably H2-receptor blocker should therefore not affect the outcome of the FOBT. Occasionally in other studies, a screening FOBT is ordered inappropriately as for patients with life-limiting comorbidities [20].…”

“…Enteral tube feeding by percutaneous endoscopic gastrostomy tube (PEG) is being used in patients with advanced dementia, dysphagia secondary to neuromuscular diseases, cachexia from cancer, and any patient who is unable to eat for prolonged period [1][2][3][4][5][6]. Thus most of the patients undergoing PEG have background severe disease, with many at risk for gastrointestinal (GI) hemorrhage.…”

Retrospective analyses of complications associated with transcutaneous replacement of percutaneous gastrostomy and jejunostomy feeding devices

“…Hemorrhaging resulting from ulcers is not caused by the procedure itself but by direct trauma from the replacement device. 20,21 We experienced 4 cases of hemorrhage after replacement. It is important to note that anticoagulation or antiplatelet agents were being administered in all 4 cases, and that administration of these agents is a risk factor of replacement-related hemorrhage.…”

Transarterial Embolization of Massive Gastric Ulcer Bleeding in Gastrostomy Patients Caused by a Balloon Replacement Tube: A Case Report

“…Explanations have been published regarding the mechanism underlying the development of gastric ulcer after balloon gastrostomy tube placement. Kanie et al (8) reported that a PEG tube with a long protruding tip was associated with a significantly higher frequency of post-PEG gastric ulcer due to contact injury to the gastric mucosa caused by the tip of the tube. In our case, the gastric ulcer was observed on the posterior wall of the gastric angle, where the tip of the balloon tube came into contact with the mucosa.…”