Persistent Gastrocutaneous Fistula after Percutaneous Gastrostomy Tube Removal

Abstract

Persistent gastrocutaneous fistula after removal of a percutaneous gastrostomy (PEG) tube is an uncommon complication [1]; the fistulous tract usually closes spontaneously within 48-72 hours. Factors involved in failure of closure are the duration of PEG tube placement, obesity, persistent cough, fibrosis of the tract, and underlying debilitating disease. Conservative approaches have included parenteral therapy, reduction of the acidic pH of the stomach, and pharmacological acceleration of the gastric emptying time [2] [3]. Traditionally, surgical therapy has been reserved for patients who prove refractory to these measures, though there have been a few reports of patients who have been managed with endoscopic clips [4] [5]. We present a patient with a persistent gastrocutaneous fistula after PEG removal who was treated endoscopically with clips placed across the internal gastric opening.