Difficulties of PEG tube insertion in patients with upper GI tract strictures

Abstract

PEG tube insertion is indicated in prolonged conditions (oncological, neurological, etc.) where adequate oral feeding is not possible, and there is no contraindication. The PEG tube insertion might not be possible in patients with oesophageal, pharyngeal or laryngeal tumor, because the bumper of the PEG tube can stuck in the stricture of the upper GI tract. Case report: In a 68 year old male patient with the history of vocal cord tumor irradiation and laryngectomy, a PEG tube insertion was attempted because of dysphagia but due to the malignant stricture of the pharyngo-oesophageal junction, it was not successful. Dilatation of the stricture was performed with a 12mm balloon. The diagnostic gastroscope easily passed the stricture after the dilatation, but during the insertion of the PEG tube (Flocare, 18 Ch) its bumper impacted in the stricture and was not removable with a foreign body forceps. Guidewire and a 7mm balloon catheter was inserted into the lumen of the PEG tube, and after inflating of the balloon, the PEG tube was easily removed. The stricture was further dilated with a 14mm balloon which allowed the PEG insertion. In patients with upper GI stricture, at least 14mm lumen diameter is needed for a safe PEG placement. This balloon method is a safe, easy and reliable way to remove an impacted PEG tube, which was successfully used in two other patients.