Intestinal passage of the PEG end-piece: is it safe?
Two rare but life-threatening complications of percutaneous endoscopic gastrostomy (PEG) are reported: small bowel perforation and obstruction. Both resulted from impaction of the PEG end-piece after separation at skin level. Review of the literature revealed very few complications from intestinal passage of PEG end-pieces. The free intragastric PEG end-piece routinely passes through the gastrointestinal tract in most cases. One of these two cases was drawn from a series of 100 patients with intentional intestinal passage of PEG end-pieces to give a severe complication rate of 1%. A case can be made for routine endoscopic per-oral removal of PEG end-pieces in the elective setting, but this is more costly and not without hazard. Previous laparotomy and/or known adhesions is a relative indication for endoscopic retrieval of the PEG end-piece. Oesophageal disease or intolerance of endoscopy is a relative indication for intestinal passage. Close clinical follow up is recommended to ensure that the PEG end-piece has passed per-rectum. If the PEG end-piece has not passed and is shown in the small bowel on plain X-ray at approximately 3 weeks after separation then lodgement has probably occurred and early operative intervention is warranted.
Coventry
B J
BJ
Department of Surgery, Queen Elizabeth Hospital, Woodville, South Australia.
Karatassas
A
A
Gower
L
L
Wilson
P
P
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D007416:Intestinal Perforation / Q000209:etiology*; D007421:Intestine, Small; D008297:Male