Replacement Of Percutaneous Endoscopic Gastrostomy Tube Research Articles

Percutaneous endoscopic gastrostomy tube replacement after head and neck surgery: A case report.

IntroductionPercutaneous endoscopic gastrostomy (PEG) has been available since the 1980s. Routine replacement is conducted at bedside with relatively few complications. Two replacement methods have come into practice: the percutaneous method and the endoscopic method. The laparoscopic method has recently become favorable in the pediatric population.Presentation of caseHerein, we describe a situation in which a gastrostomy tube was replaced at bedside on a patient with previous head and neck surgery for lingual cancer. The percutaneous traction method was used, and gastrostomy tube replacement into the gastric lumen could not be confirmed on subsequent imaging. The patient was ultimately taken to surgery for an open procedure where it was discovered that initial PEG placement had traversed the small bowel mesentery en route to the gastric lumen.DiscussionThe PEG tube is not a permanent device and routine exchange every 6–12 months is recommended. The percutaneous method and endoscopic method for gastrostomy tube replacement have both been used routinely, each with their set of complications. A third technique, laparoscopic placement, is the preferred modality in the pediatric population. Advantages are twofold: direct visualization of the stomach, thus eliminating inadvertent hollow viscus injury, and applicability in infants too small to undergo endoscopy necessary for PEG tube placement.ConclusionConsideration for laparoscopic placement or replacement in the head and neck cancer patient population, in which interval endoscopy is impossible, is thus advocated.

Factors affecting late complications of percutaneous endoscopic gastrostomy tube replacement.

Late complications associated with percutaneous endoscopic gastrostomy (PEG) tube in patients are common occurrences. We aimed to identify risk factors associated with PEG-related late complications. Patients who underwent PEG exchange were retrospectively collected from electronic medical records between January 2015 and November 2020. Medical records were reviewed longitudinally from the PEG replacement date until the first complication event, death, or the end of the study. The late complication was defined as the PEG-related complications six months after the initial PEG placement. Potential risk factors were tested using Cox proportional hazard. A total of 116 patients (mean age 80.5±17.6 years, 52.6% male) were enrolled with a 12 (4-23) months median follow-up. The indications were mostly neurologic disease (89.7%). Non-balloon PEG was used in 93 (80.2%) patients with balloon-type in 23 (19.8%) patients. PEG-related late complications developed in 35 (30.2%) patients with a median time of 9 (4-23) months. In the multivariate analysis, the PEG-related late complication rate was significantly higher in patients with balloon-type PEG tube (HR 5.54; 95%CI, 2.55-12.05; p<0.001) and also showed a significantly higher cumulative incidence of developing complications (54.9% vs. 12.8% at one year and 76% vs. 22.8% at two years, p<0.001). The most common complication was PEG dislodgement (n=14, 40%). Late-onset of PEG tube-associated complications is a common problem. The significant factor associated with PEG tube complication was balloon-type PEG placement.

Scheduled percutaneous endoscopic gastrostomy tube replacement did not reduce PEG-related complications

Background Percutaneous endoscopic gastrostomy (PEG) tube insertion is used for enteral nutrition. Each manufacturer has its own instructions for planned tube replacement. Accordingly, caregivers have adopted the policy of elective change at a fixed period of time (3–6 months). Aim The current study aimed to assess whether retained PEG for more than 6 months was associated with a higher rate of PEG-related complications. Methods A retrospective single-center study included all patients who underwent PEG insertion were included in the study. Results Overall, 303 patients were included, 48 patients (16.2%) had PEG tube replacement. Peristomal PEG tube leak was the commonest complication, occurring in 20 patients (41.7%), followed by dislodgement in 18 patients (37.5%) and obstruction in 10 patients (20.8%). Among the patients with a leak, it occurred within and beyond 6 months from PEG insertion in 40 and 60% of patients, respectively (OR 0.68, 95% CI 0.21–2.18, p = .57). Similarly, 50% of patients had PEG tube obstruction within 6 months and 50% had it beyond 6 months from insertion (OR 1.46, 95% CI 0.34–6.26, p = .72). Moreover, there was no difference in PEG dislodgement after PEG insertion within or beyond 6 months (nine patients, 50% vs. nine patients, 50%), respectively, (OR 1.37, 95% CI 0.42–4.47, p = .76). Conclusion Retained PEG tubes for more than 6-months were not associated with more PEG-tube-related complications.

Endoscopic rescue of early percutaneous endoscopy gastrostomy tube dislodgement.

Percutaneous endoscopic gastrostomy (PEG) tube placement is one of the most common methods for establishing durable enteral access. Early PEG dislodgement occurs in < 5% of cases but typically prompts urgent surgical intervention to reestablish the gastrocutaneous tract and prevent intra-abdominal sepsis. To date, there is a single case report in the literature where successful endoscopic "rescue" of an early dislodged PEG tube negated the need for operative intervention. Here, we report our experience with a series of endoscopic PEG rescues for early dislodged PEG tubes. A retrospective analysis of cases was reviewed from two institutions. Patients with early PEG dislodgements underwent PEG rescue using a gastroscope and standard Ponsky "Pull" PEG techniques through the original tract. Eleven patients were identified from the database and underwent PEG rescue after early PEG dislodgement. Mean operative time was 68min, and there were no complications related to PEG rescue. PEG rescue permitted safe re-establishment of the gastrostomy tract while avoiding laparoscopic or open surgical intervention in hemodynamically stable patients. All patients tolerated the procedure well and were able to resume use of the PEG tubes shortly after intervention. Endoscopic rescue represents a feasible noninvasive option for PEG tube replacement following early inadvertent PEG tube dislodgement in appropriate clinical settings.

1864 Gastric Outlet Obstruction as a Complication of Replaced Gastrostomy Tube

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a common procedure for the provision of long term enteral nutrition (1). Indications for PEG tube replacement include tube malfunction, dislodgement, or scheduled exchange (2). Complications of replacement include bleeding, infection, and tube misplacement (3). Gastric outlet obstruction (GOO) is a rare complication seen when the tube is inserted distal to the pylorus or the balloon is overfilled (4). CASE DESCRIPTION/METHODS: An 86-year-old woman with a history of previous stroke necessitating prolonged enteral feeding through PEG presented to the hospital due to a clogged PEG tube. The tube was replaced at bedside via the percutaneous route and gastric fluid was aspirated. The tube was noted to be 2 cm deeper than prior to the procedure. A water-soluble contrast study through the PEG tube was obtained to confirm proper position (Figure 1) which showed contrast within the small bowel. The radiologist concluded the gastrostomy tube was in satisfactory position and tube feedings were resumed. Overnight, the patient experienced several episodes dark emesis. An endoscopy the next morning revealed the gastrostomy tube balloon was inflated in the duodenal bulb causing a GOO (Figure 2). The tube was repositioned in the stomach (Figure 3) and the patient was discharged 4 days later. DISCUSSION: This case illustrates the importance of establishing a standardized approach to the confirmation and documentation of PEG tube replacement. The marker on the replacement tube should be close to that of the previous tube. Notably, resistance to traction at a greater depth than expected may represent post-pyloric placement of the balloon. Finally, when imaging is obtained, fluoroscopy should be performed at an oblique angle and contrast should be observed in the stomach to confirm correct placement.

Complications of a Minimally Invasive Procedure: The PEG Tube

Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive method of establishing enteral access by placing a tube through the gastric wall. It's one of the most common endoscopic procedures, with an estimated number of 100,000-125,000 performed annually in the US. Procedure-related complications are not uncommon; a large meta-analysis reported morbidity of 9.4% and mortality of 0.53%. Commonly reported complications are: aspiration, hemorrhage, peritonitis, gastric ulcer, fistulas, ileus, stomal leak, infection, buried bumper, visceral perforation, and accidental removal. We describe a patient who had a recent PEG tube replacement, now presenting with an upper GI bleed, found to have an ulcerated gastric wall hematoma. An 81 YOM with a PMHx of laryngeal carcinoma s/p chemoradiation and PEG tube placement due to a near complete obstruction of the cervical esophagus presented with melena and coffee ground discharge from his tube. He recently underwent PEG tube replacement due to tube malfunction; given significant stricture at the site, the tract required dilation prior to replacement. Admission labs were significant for anemia. He was not on any anticoagulation. Endoscopy via PEG site revealed a 2cm ulcer over a large non-mucosal mass in the gastric body, opposite the tube(Fig A). This was initially thought to be an ulcerated gastrointestinal stromal tumor (GIST). He was placed on a proton pump inhibitor and was scheduled for a repeat EGD and endoscopic ultrasound. During this follow up EGD there had been complete resolution of the lesion(Fig B). It was concluded that the non-mucosal lesion was likely a hematoma due to traumatic injury by passing the dilator. Traumatic placement of a PEG tube causing an ulcerated hematoma is an uncommon, frequently underreported entity that may have a similar appearance to that of a GIST. GISTs are mesenchymal neoplasms accounting for less than 1% of all GI tumors. They have a variety of appearances and can present as an intraluminal, extraluminal, solid or ulcerated mass anywhere along the GI tract. The most common site of a gastric wall hematoma includes the anterior wall due to needle insertion damaging small vessels contained within the deep submucosa. Theoretically, dilators used to relieve PEG tube strictures could cause damage to the posterior wall, however upon literature review there were no cases identified. This case emphasizes the need for caution when using dilators to treat PEG site strictures.Figure: Large non-mucosal mass with central ulceration.Figure: Complete resolution of large non-mucosal mass with central ulceration after one month.

Mo1375 To Pull or to Scope: A Prospective Safety and Cost-Effectiveness Analysis of Percutaneous Endoscopic Gastrostomy Tube Replacement Methods

Mo1375 To Pull or to Scope: A Prospective Safety and Cost-Effectiveness Analysis of Percutaneous Endoscopic Gastrostomy Tube Replacement Methods

Percutaneous Endoscopic Gastrostomy in Amyotrophic Lateral Sclerosis

Percutaneous endoscopic gastrostomy (PEG) tube placement is recommended in amyotrophic lateral sclerosis (ALS) patients with dysphagia to provide reliable access for medications and nutrition. It is preferably done while forced vital capacity (FVC) is greater than 50% of predicted to reduce risk of postprocedural respiratory complications. Percutaneous radiologic gastrostomy has been shown to have higher success rates and lower complication rates compared with PEG. The authors sought to investigate the safety of PEG placement in ALS patients with varying respiratory compromise. The records of 21 patients with ALS who underwent PEG tube placement from October 2010 to October 2013 were retrospectively reviewed to determine rates of successful placement, complication, mortality and survival. PEG was placed successfully in 95.2% of patients. There was 1 major complication, procedure-related death, and failed placement in a patient with FVC 15% predicted who developed procedure-related aspiration and hypoxic respiratory failure and death 8 days after failed PEG attempt. Minor complications included 3 patients with minor pain at insertion site, 1 patient with minor bleeding requiring cauterization and 2 patients requiring PEG tube replacement within 6 months of procedure for accidental dislodgement. After PEG placement, median survival was 327 days (95% confidence interval: 180-687). In conclusion, PEG tube placement in patients with ALS seems to be a safe procedure in patients without significant respiratory compromise. In patients with FVC <50%, based on literature review and the results of this study, the authors recommend percutaneous radiologic gastrostomy over PEG placement.

Percutaneous Endoscopic Gastrostomy Tube Replacement

BackgroundEnteral feeding should be considered for patients with an intact and functional gastrointestinal tract. Percutaneous endoscopic gastrostomy (PEG) tube placement is indicated in patients requiring medium to long term enteral feeding (>30 days) and with impaired swallowing. Previously placed PEG tube can dislodge or be inadvertently removed, blocked, or damaged. Gastrostomy tube replacement is not infrequently performed. Patients and methodsIn this video manuscript, the author demonstrates step-by-step PEG tube replacement in several clinical scenarios: standard gastrostomy feeding tube (with internal retention balloon or with internal collapsible bumper) removal and replacement; low-profile feeding tube replacement; and feeding tube replacement over a wire guide. ConclusionsPEG tube replacement can be easily replaced at bed-side in most cases. Occasionally, in difficult cases gastrostomy feeding tube replacement needs endoscopic guidance and assistance.

Two Cases of Uncommon Complication during Percutaneous Endoscopic Gastrostomy Tube Replacement and Treatment

We presented two interesting cases of gastrocolocutaneous fistula that occurred after percutaneous endoscopic gastrostomy (PEG) tube placement, and its management. This fistula is a rare complication that occurs after PEG insertion, which is an epithelial connection between mucosa of the stomach, colon, and skin. The management of the fistula is controversial, ranging from conservative to surgical intervention. Endoscopists should be aware of the possibility of gastrocolocutaneous fistula after PEG insertion, and should evaluate the risk factors that may contribute to the development of gastrocolocutaneous fistula before the procedure. We reviewed complications of gastrostomy tube insertion, symptoms of gastrocolocutaneous fistula, and its risk factors.

Percutaneous Endoscopic Gastrostomy Tube Replacement Unexpected Serious Events

Percutaneous endoscopic gastrostomy tubes are replaced due to clogging, breaking, and dislodgement. There are potential complications associated with these procedures, including intraperitoneal placement of the tube and peritonitis, which can occur even in the presence of a well established stoma site. Herein we present a case series of 3 patients with mature gastrocutaneous tracks, who developed peritonitis following tube replacement. In the absence of a consensus or international guidelines regarding the management of patients requiring percoutaneous endoscopic gastrostomy tube replacement, emphasis should be given on prevention of severe adverse events and on early anticipation of their occurrence. Clinical experience indicates that recognition of high-risk procedures, selection of the appropriate replacement method and confirmation of correct tube placement can improve patients' safety and reduce the complications rate.

Comparison of Complications between Endoscopic and Percutaneous Replacement of Percutaneous Endoscopic Gastrostomy Tubes

When replacing percutaneous endoscopic gastrostomy (PEG) tubes, an internal bolster may be retrieved either percutaneously or endoscopically. The aim of this study was to compare the complications of percutaneous and endoscopic method during PEG tube replacement. The medical records of 330 patients who received PEG tube replacement were retrospectively analyzed. According to the removal method of internal bolster, we categorized as endoscopic group and percutaneous group. Demographic data, procedure-related complications and risk factors were investigated. There were 176 cases (53.3%) in endoscopic group and 154 cases (46.7%) in percutaneous group. The overall immediate complication rate during PEG tube replacement was 4.8%. Bleeding from the stoma (1.3%) occurred in percutaneous group, whereas esophageal mucosal laceration (7.4%) and microperforation (0.6%) occurred in endoscopic group. The immediate complication rate was significantly lower in the percutaneous method (OR, 6.57; 95% CI, 1.47-29.38, P=0.014). In multivariate analysis, old age was a significant risk factor of esophageal laceration and microperforation during PEG tube replacement (OR, 3.83; 95% CI, 1.04-14.07, P=0.043). The percutaneous method may be more safe and feasible for replacing PEG tubes than the endoscopic method in old patients.

Percutaneous endoscopic gastrostomy tube replacement: A simple procedure?

Replacement of gastrostomy tube in patients undergoing percutaneous endoscopic gastrostomy (PEG) is generally considered as a safe and simple procedure. However, it could be associated with serious complications, such as gastrocutaneous tract disruption and intraperitoneal tube placement, which may lead to chemical peritonitis and even death. When PEG tube needs a replacement (e.g., occlusion or breakage of the tube), clinicians must realize that the gastrocutaneous tract of PEG is more friable than that of surgical gastrostomy because there is no suture fixation between gastric wall and abdominal wall in PEG. In general, the tract of PEG begins to mature in 1-2 wk after placement and it is well formed in 4-6 wk. However, this process could take a longer period of time in some patients. Accordingly, this article describes three major principles of a safe PEG tube replacement: (1) good control of the replacement tube along the well-formed gastrocutaneous tract; (2) minimal insertion force during the replacement, and, most importantly; and (3) reliable methods for the confirmation of intragastric tube insertion. In addition, the management of patients with suspected intraperitoneal tube placement (e.g., patients having abdominal pain or signs of peritonitis immediately after PEG tube replacement or shortly after tube feeding was resumed) is discussed. If prompt investigation confirms the intraperitoneal tube placement, surgical intervention is usually required. This article also highlights the fact that each institute should have an optimal protocol for PEG tube replacement to prevent, or to minimize, such serious complications. Meanwhile, clinicians should be aware of these potential complications, particularly if there are any difficulties during the gastrostomy tube replacement.

Long-term percutaneous endoscopic gastrostomy: characteristic computed tomographic findings

Patients with a long-term PEG may suffer from complications and received physical and endoscopic examinations. However, these examinations do not provide information between skin and stomach. We present the findings of computed tomography (CT) for patients with long-term percutaneous endoscopic gastrostomy (PEG). After 1 year PEG (183 patients), 57 patients had received CT examinations. Skin indentation, soft-tissue thickening, peritoneal gap, internal bumper migration, and clinical abnormalities detected by CT examination were recorded. Thickness of subcutaneous fat, muscle, and abdominal wall along the tract were measured. The same parameters at 3 cm away from the tract were obtained for comparison. CT demonstrated that 28 (49.1%) patients present soft-tissue thickening, 19 (33.3%) patients present skin indentation, and 24 (42.1%) patients present a peritoneal gap. One patient with internal bumper migration, 3 patients had buried bumper syndrome, 2 patients had gastric herniation, and 1 patient had esophageal cancer metastasizes to the PEG site. Thickness of subcutaneous fat, muscle, and abdominal wall decreased significant. CT can provide detailed anatomy and orientation along the PEG tube. Familiarity of the CT appearance can minimize potential complications before PEG tube replacement.

A case of gastrocolocutaneous fistula as a complication of percutaneous endoscopic gastrostomy.

A rare complication of percutaneous endoscopic gastrostomy (PEG) is gastrocolocutaneous fistula which usually occurs after replacement of the PEG tube. As tube feeding is directly delivered to the transverse colon, patients typically present with a sudden onset of transient diarrhea within minutes after PEG tube feeding. A radiographic study using water-soluble contrast material via the PEG tube shows the tip of the tube in the transverse colon. We present here a patient who had this complication after PEG insertion. A PEG tube for enteral feeding was placed in a 27-year-old man with cerebral plasty and a severe scoliosis. After replacement of the PEG tube, he developed diarrhea after each PEG tube feeding. The diagnosis of gastrocolocutaneous fistula was made after injection of gastrografin from the PEG tube. Another gastrostomy tube was placed surgically and the fistula was then also excised. In conclusion, gastrocolocutaneous fistula must be considered as a complication of PEG tube placement when patients with a PEG tube develop a sudden onset of transient diarrhea immediately after PEG tube feeding.

Intestinal Obstruction After PEG Tube Replacement: Implications to Daily Clinical Practice

One method commonly employed to remove percutaneous endoscopic gastrostomy (PEG) tubes is to disconnect the internal flange from the rest of the tube at skin level. The internal segment is then allowed to pass spontaneously through the gastrointestinal tract. This report describes a case in which the internal flange resulted in intestinal obstruction in a patient with underlying Crohn disease, necessitating surgical removal. The limited published literature relating to risks of retained PEG flanges is reviewed. This suggests that in patients with underlying gastrointestinal disease and other risk groups, disconnected internal PEG flanges should be retrieved endoscopically in preference to allow spontaneous passage.

Colocutaneous Fistula Causing Diarrhea: A Complication of PEG Tube Replacement

Purpose: Percutaneous endoscopic gastrostomy (PEG) tube placement leading to fistula formation is rare and colocutaneous fistula due to PEG placement has been reported in less than ten cases. Case: A 37 year old male with cerebral palsy and congenital quadriplegia, with PEG tube for enteral nutrition presented with persistent diarrhea of 2 weeks duration leading to hypokalemia and hypernatremia. Stool studies including clostridium difficile toxin, ova and parasites, and cultures were negative. PEG residuals were yellowish and had fecal odor. Further inquiry revealed there was a bedside replacement of PEG tube 2 weeks ago, which coincided with the onset of diarrhea. Gastrograffin through PEG tube and computed axial tomography scan showed the presence of the tube in the transverse colon and an absence of gastrocolic fistula. Diarrhea resolved after discontinuing tube feedings. Discussion: Apart from infection and bleeding, PEG placement can also cause rare complications such as gastrocolic, jejunocutaneous and colocutaneous fistulae. These can occur when loop of intestine gets transfixed between the stomach and the abdominal wall during tube placement. Also, these fistulae may remain asymptomatic after initial procedure and become symptomatic only after PEG replacement. Usually dysfunctional PEG tubes are replaced at the bed side without any radiologic or endoscopic guidance and the replaced tube may remain localized in the colon without proper advancement into the stomach. Conclusion: After bedside replacement of the gastrostomy tube, a strong consideration should be given to radiographically confirm the location of the luminal end. Furthermore, recognize colocutaneous fistula as a cause for persistent diarrhea after PEG replacement.

BURIED BUMPER SYNDROME AS A COMPLICATION OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN CANCER PATIENTS: THE BRAZILIAN EXPERIENCE

Background: Buried bumper syndrome (BBS) is a major complication of percutaneous endoscopic gastrostomy (PEG) in which the internal bumper migrates from the gastric lumen into the gastrostomy tract. The aim of the present study was to describe the frequency and characteristics of BBS in cancer patients. Methods: Retrospective chart review of cancer patients submitted to PEG placement. Results: Thirteen cases of BBS were diagnosed among 213 PEG procedures, with an incidence of 6.1%. The interval between PEG and BBS varied from 7 to 630 days (mean 217.5 days). All patients were treated on an outpatient basis. There were six partial, four subtotal and three total BBS. Three partial and four subtotal BBS were treated by external traction and replacement with a balloon-tipped tube. In three cases of partial BBS the PEG tube was not removed, just repositioned. In three cases of total BBS it was necessary to redo the PEG procedure. Conclusion: BBS is an uncommon and usually late complication of PEG. Most of our cases were detected early, due to instructions provided to patients and caregivers and regular follow up. Early diagnosis permits simple treatment consisting of replacement of the original PEG tube by a balloon-tube or repositioning the original system.

Comparison of Gastrostomy Tube Replacement Verification Using Air Insufflation Versus Gastrograffin

Burke DT, El Shami A, Heinle E, Pina B. Comparison of gastrostomy tube replacement verification using air insufflation versus gastrograffin. Objective To compare the safety of air insufflation as a contrast medium for percutaneous endoscopic gastrostomy (PEG) tube replacement verification with that of the more traditional method using positive contrast material (gastrograffin) under fluoroscopic guidance. Design Retrospective case series comparing 2 radiographic procedures used for PEG tube verification at a rehabilitation hospital. The first series reviewed studies of patients over 1 year, during which the method of choice for PEG tube replacement verification was with air insufflation. The second series reviewed studies of patients over the subsequent year, during which the method of choice for PEG tube replacement verification was with gastrograffin. Setting An inpatient rehabilitation hospital. Participants Nineteen patients and 29 PEG tube replacements were identified that used air insufflation and 17 patients and 19 PEG tube replacements were identified that used gastrograffin. Interventions Not applicable. Main Outcome Measures Medical complications in a 2-week follow-up period as a result of the verification procedures. Results There were no cases in either of the replacement procedures in which the PEG tube was found to not be in the gastrointestinal system. There was also no evidence at 2-week follow-up that any of the patients’ complications were the result of either procedure. Conclusions The air contrast procedure appears to be a relatively safe alternative procedure for PEG tube replacement verification.

Hemoperitoneum after accidental dislodgement and subsequent replacement of PEG tube

Percutaneous endoscopic gastrostomy (PEG) tubes require replacement for a variety of reasons, including accidental dislodgement by the patient. It is generally accepted that insertion of a replacement tube or “button” without endoscopic visualization is safe in the presence of a mature gastrocutaneous tract as long as it is done promptly, before the tract closes. 1 Marshall JB Bodnarchuk G Barthel JS Early accidental dislodgement of PEG tubes. J Clin Gastroenterol. 1994; 8: 210-212 Crossref Scopus (45) Google Scholar There have been relatively few reports of significant complications after blind insertion of such replacement devices, namely gastrostomy tract disruption. Most of these occurred with replacement using the gastrostomy button. 2 Gauderer MWL Gastrostomy techniques and devices. Surg Clin North Am. 1992; 72: 1285-1298 PubMed Google Scholar , 3 Fox VL Abel SD Malas S Duggan C Leichtner AM Complications following percutaneous endoscopic gastrostomy and subsequent catheter replacement in children and young adults. Gastrointest Endosc. 1997; 45: 64-71 Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar , 4 Romero R Martinez FL Robinson SY Sullivan KM Hart MH Complicated PEG-to-skin level gastrostomy conversions: analysis of risk factors for tract disruption. Gastrointest Endosc. 1996; 44: 230-234 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar , 5 Mago H Chen CL Wesson DE Filler RM Incisionless gastrostomy for nutritional support. J Pediatr Gastroenterol Nutr. 1986; 5: 66-69 Crossref PubMed Scopus (23) Google Scholar , 6 McQuaid KR Little TE Two fatal complications related to gastrostomy “button” placement. Gastrointest Endosc. 1992; 38: 601-603 Abstract Full Text PDF PubMed Scopus (48) Google Scholar This is a report of a rare, near-fatal case of inadvertent intraperitoneal insertion of a balloon replacement tube through a mature gastrocutaneous tract with resultant peritonitis and hemoperitoneum.