PEG "Rescue": a practical NOTES technique.
Dislodged percutaneous endoscopic gastrostomy (PEG) tubes occur commonly and may require urgent surgical intervention in a susceptible patient population. Natural orifice translumenal endoscopic surgery (NOTES) may facilitate PEG rescue and avoid the morbidity associated with contemporary surgical techniques. We report a case of a dislodged PEG tube in the early post-operative period with evidence of incomplete gastrocutaneous tract formation and intra-abdominal leakage. Bedside transgastric NOTES exploration facilitated peritoneoscopy, evacuation of intra-abdominal fluid, and re-establishment of the PEG tube through the original gastrotomy tract. Tube feeds were resumed and postoperative contrast fluoroscopy demonstrated no intra-abdominal leakage from the replaced PEG tube. No postoperative complications related to the NOTES procedure were noted at 30 days of follow-up. PEG rescue represents a unique, practical, and empowering application of the burgeoning experience of NOTES.


BACKGROUND
The online version of this article (doi: 10.1007/s464-007-9361-2) contains supplementary material, which is available to authorized users.
Marks
Jeffrey M
JM
Department of Surgery, Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA. jeffrey.marks@uhhospitals.org
Ponsky
Jeffrey L
JL
Pearl
Jonathan P
JP
McGee
Michael F
MF
D000368:Aged; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004750:Enteral Nutrition / Q000009:adverse effects*; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011860:Radiography, Abdominal; D016879:Salvage Therapy