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Intestinal passage of the PEG end‐piece: Is it safe?
Author(s) -
COVENTRY BRENDON J.,
KARATASSAS ALEX,
GOWER LISA,
WILSON PETER
Publication year - 1994
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.1994.tb01732.x
Subject(s) - medicine , percutaneous endoscopic gastrostomy , peg ratio , laparotomy , surgery , perforation , endoscopy , gastrostomy , bowel obstruction , punching , materials science , finance , economics , metallurgy
Two rare but life‐threatening complications of percutaneous endoscopic gastrostomy (PEG) are reported: small bowel perforation and obstruction. Both resulted from impaction of the PEG end‐piece after separation at skin level. Review of the literature revealed very few complications from intestinal passage of PEG end‐pieces. The free intragastric PEG end‐piece routinely passes through the gastrointestinal tract in most cases. One of these two cases was drawn from a series of 100 patients with intentional intestinal passage of PEG end‐pieces to give a severe complication rate of 1%. A case can be made for routine endoscopic per‐oral removal of PEG end‐pieces in the elective setting, but this is more costly and not without hazard. Previous laparotomy and/or known adhesions is a relative indication for endoscopic retrieval of the PEG end‐piece. Oesophageal disease or intolerance of endoscopy is a relative indication for intestinal passage. Close clinical follow up is recommended to ensure that the PEG end‐piece has passed per‐rectum. If the PEG end‐piece has not passed and is shown in the small bowel on plain X‐ray at ∼3 weeks after separation then lodgement has probably occurred and early operative intervention is warranted.