Percutaneous Endoscopic Gastrostomy Tube Replacement Unexpected Serious Events

Abstract

Percutaneous endoscopic gastrostomy tubes are replaced due to clogging, breaking, and dislodgement. There are potential complications associated with these procedures, including intraperitoneal placement of the tube and peritonitis, which can occur even in the presence of a well established stoma site. Herein we present a case series of 3 patients with mature gastrocutaneous tracks, who developed peritonitis following tube replacement. In the absence of a consensus or international guidelines regarding the management of patients requiring percoutaneous endoscopic gastrostomy tube replacement, emphasis should be given on prevention of severe adverse events and on early anticipation of their occurrence. Clinical experience indicates that recognition of high-risk procedures, selection of the appropriate replacement method and confirmation of correct tube placement can improve patients' safety and reduce the complications rate.

Is percutaneous radiologic gastrostomy safer than percutaneous endoscopic gastrostomy?

“…[16] However, an additional meta-analysis of head-andneck cancer patients showed higher rates of complications in PRG when compared to PEG. [10] Furthermore, there are studies that do not show any difference between the two techniques. [2,6] ese studies are all retrospective and contain various definitions of major and minor adverse events.…”

“…Major complications include peritonitis, intra-abdominal infection, hemorrhage requiring transfusion or subsequent interventional procedures, and aspiration. [8][9][10] Minor complications include tube clogs, leaks, minor bleeds, and wound infections. ere is also a theoretical complication of seeding malignancy from the upper digestive tract into the stomach or along the gastrostomy tract.…”

Some Mushrooms are Hard to Digest: Gastrostomy Tube Exchange

“…Often, PEG tube needs replacement due to occlusion of the lumen or other factors. Replacement of gastrostomy tube is generally considered as a safe and simple procedure, even though various well-known complications include interruption of the continuity of the tract, incorrect tube placement in the peritoneum, peritonitis due to leakage of gastric contents and even death [ 2 , 5 , 7 ]. Anterograde extraction and the “cut and push” technique are the two commonly performed methods of PEG tube removal.…”

Assessment of the effect of colored beverage on gastric returns after gastric tube replacement to enhance placement verification

“…Education to promote competency should be provided for those who replace G tubes with emphasis on the prevention of adverse events or early recognition of their occurrence. This should include knowledge of factors such as tract maturity, procedure, and tube type as well as patient condition 19,25 . Major principles including control of the replacement tube along the well‐formed gastrocutaneous tract, minimal insertion force during replacement and most importantly, reliable methods for confirmation of intragastric tube insertion should be significant factors in this education and competency training 16 …”

“…16,17 Elective G tube exchange may be contraindicated <6 weeks postplacement and, in some cases, it may be prudent to wait at least 2-3 months, 18 especially if the person is malnourished. 14 Reports exist of peritonitis post-PEG tube replacement involving established gastrocutaneous tracts of 30 days or longer 13,19 and even as long as 9-12 months post-tube placement. 18 Factors that may delay tract maturity and increase risk for tract disruption include age, gender, nutrition status, prior exposure to corticosteroids, underlying diagnoses, chemotherapy, or radiation therapy, 18 immunocompromised status, and ascites.…”