PERCUTANEOUS ENDOSCOPIC GASTROSTOMY – “REMOVAL UNEXPECTED COMPLICATION”

Résumé fourni par la source

Description: Percutaneous endoscopic gastrostomy (PEG) tube removal is recommended after patients resume oral intake. There are three main techniques described to remove a PEG tube: (1) external traction at the skin level, (2) the cut and push technique, and (3) retrograde esophageal exteriorization under endoscopic control. The choice depends mainly on endoscopist's preferences and local guidelines. Several risk factors for tube deterioration have been described, such as heat and fungal colonization. We report the case of an 83-year-old patient with a PEG inserted 2 years ago, due to dysphagia in the context of Parkinson's disease. After placement, patient missed all booked appointments. Two years later, the patient's relatives contacted our Department to inform that the patient had resumed oral intake one year ago, and that they weren't using the feeding tube ever since. Initially, we tried to remove the tube endoscopically through the mouth as is standard practice in our department. During the procedure an esophageal laceration occurred at the lower esophageal sphincter due to the rigidity of the bumper. Given the risk of attempting to remove through the esophagus, we decided to remove the PEG tube through the gastrostomy tract. Given the rigidity of the bumper, we performed multiple radial incisions on the bumper using laparoscopic scissors inserted through the gastrostomy tract, to facilitate its collapse when extracting it through the stoma. At the end of the procedure we confirmed that the PEG tube was rigid, demonstrating marked decrease in its elasticity. Culture of the PEG material showed fungal colonization (hyphae growth). Motivation: We highlight this case by the possibility of using the gastrostomy as an alternative gateway. Moreover, endoscopists which remove PEG tubes through the oral route, should be aware that several factors can modify the tubes' original properties and therefore hinder the exteriorization using the oral route.

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