Background and Study Aims: The present study was carried out in order to elucidate the mechanism of the development of gastric ulcer, one of the serious complications of PEG tube placement.
Patients and Methods: This retrospective study included 92 patients who underwent gastric endoscopy after PEG tube placement. Gastric ulcers detected at gastroscopy were examined in relation to the length of the protrusion from the PEG tubes intragastric bumper and the use of histamine H2-receptor antagonists.
Results: Gastric ulcers were found in nine of the 92 patients, and in all nine the ulcer was found on the posterior wall of the gastric body, where the tip of the PEG tube was attached. Seven of the 21 patients (33.3 %) who had a PEG tube with a long protrusion from the intragastric bumper developed gastric ulcer. By contrast, only two of the 71 patients (2.8 %) who had a PEG tube with a short protrusion developed gastric ulcer. The use of H2-blockers had no significant impact on the development of gastric ulcer.
Conclusions: The occurrence of gastric ulcer after PEG placement was attributable to the shape of the PEG tube within the intragastric space, and not to the use of H2-blockers, suggesting that appropriate placement of the PEG tube is an important factor in preventing gastric ulcer.
References
-
1
Norton B, Homer-Ward M, Donnelly M T. et al .
A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke.
Br Med J.
1996;
312
13-16
-
2
Park R H, Allison M C, Lang J. et al .
Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia.
Br Med J.
1992;
304
1406-1409
-
3
Kanie J, Kono K, Yamamoto T. et al .
Gastro-esophageal reflex successfully treated with transgastrostomal jejunal tube feeding.
Jpn J Geriatr.
1997;
34
60-64
-
4
Haslam N, Hughes S, Harrison R F.
Peritoneal leakage of gastric contents, a rare complication of percutaneous endoscopic gastrostomy.
J Parenter Enteral Nutr.
1996;
20
433-434
-
5
Fox V L, Abel S D, Malas S. et al .
Complications following percutaneous endoscopic gastrostomy and subsequent catheter replacement in children and young adults.
Gastrointest Endosc.
1997;
45
64-71
-
6
Petersen T I, Kruse A.
Complications of percutaneous endoscopic gastrostomy.
Eur J Surg.
1997;
653
351-356
-
7
Patel A S, DeRidder P H, Alexander T J. et al .
Candida cellulitis: a complication of percutaneous endoscopic gastrostomy.
Gastrointest Endosc.
1989;
35
571-572
-
8
Martindale R, Witte M, Hodges G. et al .
Necrotizing fasciitis as a complication of percutaneous endoscopic gastrostomy.
J Parenter Enteral Nutr.
1987;
11
583-585
-
9
Kanie J, Kono K, Kono T. et al .
Complications of percutaneous endoscopic gastrostomy in the elderly: local skin infection and respiratory infection.
Jpn J Geriatr.
2000;
37
143-148
-
10
Mutabagani K H, Townsend M C, Arnold M W.
PEG ileus: a preventable complication.
Surg Endosc.
1994;
8
694-697
-
11
McGovern R, Barkin J S, Goldberg R I. et al .
Duodenal obstruction: a complication of percutaneous endoscopic gastrostomy tube migration.
Am J Gastroenterol.
1990;
85
1037-1038
-
12
Stefan M M, Holcomb G W 3rd, Ross A J 3rd.
Cologastric fistula as a complication of percutaneous endoscopic gastrostomy.
J Parenter Enteral Nutr.
1989;
13
554-556
-
13
Fireman Z, Yunis N, Coscas D. et al .
The buried gastrostomy bumper syndrome.
Harefuah.
1996;
131
92-93
-
14
Gawenda M, Schmidt R, Schonau E.
The “buried bumper” syndrome: a rare complication of percutaneous endoscopic gastrostomy.
Chirurg.
1996;
67
752-753
-
15
Klein S, Heare B R, Soloway R D.
The “buried bumper syndrome”: a complication of percutaneous endoscopic gastrostomy.
Am J Gastroenterol.
1990;
85
448-451
-
16
Gauderer M WL, Ponsky J L, Izant R J Jr.
Gastrostomy without laparotomy: a percutaneous technique.
J Pediatr Surg.
1980;
15
872-875
-
17
Kanie J, Kono K, Yamamoto T. et al .
Usefulness and problems of percutaneous endoscopic gastrostomy in a geriatric hospital.
Jpn J Geriatr.
1998;
35
543-547
-
18
Jain N K, Larson D E, Schroder D D. et al .
Antibiotic prophylaxis for percutaneous endoscopic gastrostomy: a prospective, randomized, double-blind clinical trial.
Ann Intern Med.
1989;
107
824-828
-
19
Yoshimine N, Miura S, Funaki C. et al .
Long-term nasogastric feeding and complications of acute gastric ulcer in two elderly patients.
Jpn J Geriatr.
1992;
29
667-671
-
20
Corboy E D Jr, Clay G A, Fakouhi D T. et al .
Humanitarian use of misoprostol in severe refractory upper gastrointestinal disease.
Am J Med.
1987;
83
49-52
J. Kanie, M.D.
Dept. of Internal Medicine · Fukiage Digestive Endoscopy Center
3-7-18, Chikusa, Chikusa-ku · Nagoya-si, Aichi-ken · Japan ·
Fax: +81- 52-7323250
Email: mail@fukiage-clinic.com
