title: Percutaneous endoscopic gastrostomy tube occlusion in malignant peritoneal carcinomatosis-induced bowel obstruction.
abstract: OBJECTIVE
  Percutaneous endoscopic gastrostomy (PEG) tube placement for decompression in advanced peritoneal carcinomatosis with bowel obstruction is a safe and feasible palliative procedure. We describe a rare, previously unreported phenomenon of PEG tube occlusion by gastric mucosal herniation.
  
  
  METHODS
  A consecutive case series of 73 patients with advanced abdominal carcinomatosis-induced bowel obstruction from January 2007 to June 2010. All patients had a 28 Fr (Bard) PEG tube placed for drainage. None of them were surgical candidates due to extensive peritoneal involvement. Patients with PEG tube occlusion as a result of gastric mucosal herniation were further evaluated.
  
  
  RESULTS
  Nineteen patients were men and 54 were women. The mean age was 53.3 years. The most common cancer types were ovary, pancreas, colon, and stomach. All patients had PEG tube functioning well after the procedure with immediate relief of obstructive symptoms. Subsequently, 10 patients developed acute occlusion of PEG tubes with reoccurrence of obstructive symptoms. The time between the placement of the PEG tube and its occlusion ranged from 5 to 129 days. Repeat endoscopy showed the PEG tube occluded with gastric mucosa from the opposite wall. PEG tube was replaced with a 28 Fr balloon replacement tube leading to symptom improvement in all 10 patients.
  
  
  CONCLUSIONS
  This rare but correctable phenomenon of obliteration of PEG tube from the gastric mucosa should be considered in any patient who develops intermittent occlusive symptoms. This phenomenon can be corrected by replacing the PEG tube with a ballooned replacement tube as well as occasional manipulation of the tube.
authors: Department of Nutrition and Metabolic Research, Cancer Treatment Centers of America at Midwestern Regional Medical Center, Zion, Illinois 60099, USA.
authors: Pankaj G
authors: PG
authors: Vashi
authors: Sadie
authors: S
authors: Dahlk
authors: Rohan P
authors: RP
authors: Vashi
authors: Digant
authors: D
authors: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D004868:Equipment Failure; D005260:Female; D005773:Gastroscopy / Q000295:instrumentation; D005774:Gastrostomy / Q000295:instrumentation*; D006547:Hernia / Q000150:complications; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D010534:Peritoneal Neoplasms / Q000150:complications*; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult