title: An unusual complication of PEG feeding after pancreatico-gastrostomy.
abstract: BACKGROUND
  We describe a late complication of the pancreatico-gastrostomy (PG) anastomosis following pancreatico-duodenectomy (PD).
  
  
  METHODS
  A percutaneous endoscopic gastrostomy (PEG) feeding tube was inserted many months post-operatively. In this patient activated pancreatic enzymes eroded the gastrostomy tract, resulting in pain, recurrent infection and eventual removal of the gastrostomy tube.
  
  
  CONCLUSIONS
  Where surgical insertion of a feeding jejunostomy is not viable or deemed too high risk after Whipple or PPPD, we recommend careful consideration of PEG tube insertion in patients with PG reconstruction. If a PEG is used the prophylactic use of Lanreotide is recommended.
authors.affiliation: Royal Surrey County Hospital, Guildford, UK. mary.phillips1@nhs.net.
authors.forename: Mary
authors.initials: M
authors.lastname: Phillips
authors.forename: Katy
authors.initials: K
authors.lastname: Hosie
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Griffiths
authors.forename: Nadeen
authors.initials: N
authors.lastname: Low
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Gallagher
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Tibbs
authors.forename: Nariman D
authors.initials: ND
authors.lastname: Karanjia
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000009:adverse effects*; D004789:Enzyme Activation; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D010179:Pancreas / Q000201:enzymology*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010456:Peptides, Cyclic / Q000627:therapeutic use; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D010456:Peptides, Cyclic; C060347:lanreotide; D013004:Somatostatin