1880 Failure of Withdrawal Through the Abdominal Wall - A New Percutaneous Gastrostomy Tube Placement Complication: A Case Series

Abstract

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) tubes are the preferred method for long-term nutritional support, having a success rate of 95 to 100% regardless of the technique. Common reasons for failed endoscopic gastrostomy tube placements are complete oropharyngeal or esophageal obstruction, suboptimal gastric transillumination, or deterioration in the clinical status during the procedure. Aim: present the first case series of three patients with unsuccessful PEG tube placements because of failure to withdrawal the gastrostomy tube through the abdominal wall. CASE DESCRIPTION/METHODS: Methods: We conducted a MEDLINE database query by combining the search terms “Gastrostomy and adverse effects”, “Gastrostomy and methods”, “Gastroscopy” and “Percutaneous Endoscopic Gastrostomy”. The resultant 408 articles were pulled from the literature. English language article titles and abstracts were screened, and the appropriate articles reviewed. No previous case reports of unsuccessful PEG placement secondary to failed withdrawal of the PEG tube through the abdominal wall. We report three cases. All clinical data were carefully reviewed. Exclusion criteria was failure of PEG placement due to other circumstances (such as inability to pass the scope, inadequate gastric transillumination on the abdominal wall, absence of endoscopic confirmation of digital imprint upon external pressure, or failed needle insertion). Results:Three patients were included (two females, one male). The average age was 62 years old (range 58 to 66 years). All of the cases presented unsuccessful PEG placement using the Flow 20 Pull® PEG tube (Cook Medical®, Winston-Salem, North Carolina). Two of the three patients had pneumoperitoneum, one with generalized peritonitis after the failed PEG attempt, requiring exploratory laparotomy. DISCUSSION: This is the first report of patients with unsuccessful PEG placement secondary to the inability to withdraw the gastrostomy tube through the abdominal wall. Failure was likely caused from the tangential entrapment of the PEG tube tip in the gastric wall or subcutaneous tissue. We hypothesize that this may be related to the short and blunt - shaped tip of the Flow 20 Pull® PEG tube (Cook Medical®). Endoscopists other than the authors have reported difficulty withdrawing this PEG tube through the abdominal wall (personal communication).