Percutaneous endoscopic gastrostomy (PEG) is used to restore enteral nutrition in patients with inadequate oral intake. Because of its minimally invasive nature complications are thought to be rare. We analyzed data on all patients treated for PEG-related complications at the Department of General, Visceral, and Oncologic Surgery at the Klinikum Bremen-Mitte, Germany, between 2005 and 2008. A total of 38 patients with complications required surgical evaluation. Emergency laparotomy was performed for leakage in 16 patients, for a misplaced or dislodged PEG tube in nine patients, for buried bumper with accompanying signs of peritonitis in four patients and for gastrocutaneous fistula in one patient. Eight complications were managed conservatively. Early complications within 10 days (60 %) were related to leakage or mispositioning of the PEG, while PEG device migration and fistula formation represented late complications. Hospital mortality was 17 % with the underlying disease contributing significantly to the fatal outcome. Most PEG-associated major complications were related to technical errors and carried a high mortality.
References
-
1
Gauderer M, Ponsky J, Izant R.
Gastrostomy without laparotomy: a percutaneous endoscopic technique.
J Pediatr Surg.
1980;
15
872-875
-
2
Lynch C R, Fang J C.
Prevention and management of complications of percutaneous endoscopic gastrostomy (PEG) tubes.
Pract Gastroenterol.
2004;
28
66-76
-
3
Chaer R A, Rekkas D, Trevino J. et al .
Intrahepatic placement of a PEG tube.
Gastrointest Endosc.
2003;
57
763-765
-
4
Guloglu R, Taviloglu K, Alimoglu O.
Colon injury following percutaneous endoscopic gastrostomy tube insertion.
J Laparoendosc Adv Surg Tech A.
2003;
13
69-72
-
5
Schrag S P, Sharma R, Jaig N P. et al .
Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review.
J Gastrointestin Liver Dis.
2007;
4
407-418
-
6
Beres A, Bratu I, Laberge J-M.
Attention to small details: big deal for gastrostomies.
Semin Pediatr Surg.
2009;
18
87-92
-
7
Lee T H, Shih L N, Lin J T.
Clinical experience of percutaneous endoscopic gastrostomy in Taiwanese patients – 310 cases in 8 years.
J Formos Med Assoc.
2007;
106
685-689
-
8
McClave S A, Jafri N S.
Spectrum of morbidity related to bolster placement at time of percutaneous endoscopic gastrostomy: buried bumper syndrome to leakage and peritonitis.
Gastrointest Endosc Clin N Am.
2007;
17
731-746
-
9
Lau G, Lai S H.
Fatal retroperitoneal haemorrhage: an unusual complication of percutaneous endoscopic gastrostomy.
Forensic Sci Int.
2001;
116
69-75
-
10
Bunai Y, Akaza K, Nagai A. et al .
Iatrogenic rupture of the left gastric artery during percutaneous endoscopic gastrostomy.
Legal Med.
2009;
11
538-540
-
11
Lewis M, Lewis J, Marshall H, Lossef S.
Massive hemorrhage complicating percutaneous endoscopic gastrostomy: Treatment by means of transcatheter embolization of the right and left gastroepiploic arteries.
J Vasc Interv Radiol.
1999;
10
319-323
-
12
Smyth G, McGreal G, McDermott E.
Delayed presentation of a gastric colocutaneous fistula after percutaneous endoscopic gastrostomy.
Nutrition.
2003;
19
905-906
-
13
Sookpotarom P, Vejchapipat P, Chongsrisawat V, Mahayosnond A.
Gastric volvulus caused by percutaneous endoscopic gastrostomy: a case report.
J Pediatr Surg.
2005;
40
21-23
-
14
Kubiak R, Wilcox D, Spitz L.
Gastrojejunal fistula after insertion of percutaneous endoscopic gastrostomy.
J Pediatr Surg.
1999;
34
1287-1288
-
15
Bumpers H, Collure D, Best I. et al .
Unusual complications of long-term percutaneous gastrostomy tubes.
J Gastrointest Surg.
2003;
7
917-920
-
16
Lee T-H, Lin J-T.
Clinical manifestations and management of buried bumper syndrome in patients with percutaneous endoscopic gastrostomy.
Gastrointest Endosc.
2008;
68
580-584
-
17
Vervloessem D, van Leersum F, Boer D. et al .
Percutaneous endoscopic gastrostomy (PEG) in children is not a minor procedure: risk factors for major complications.
Semin Pediatr Surg.
2009;
18
93-97
-
18
Campoli P MO, Cardoso D MM, Turchi M D. et al .
Assessment of safety and feasibility of a new technical variant of gastropexy for percutaneous endoscopic gastrostomy: an experience with 453 cases.
BMC Gastroenterology.
2009;
9
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T. LehnertMD
Department of General, Visceral and Oncologic Surgery
Klinikum Bremen-Mitte
St.-Juergen-Str. 1
D-28177 Bremen
Fax: +49-421-4973307
Email: thomas.lehnert@klinikum-bremen-mitte.de
