Percutaneous Gastrostomy Tube Research Articles

Baker's Yeast Might not always be Good for Everyone - A Case of Percutaneous Gastrostomy Tube Induced Saccharomyces Cerevisiae Peritonitis in an Immunocompromised Patient.

Fungal infection can be a cause of peritonitis especially in an immunocompromised patient.Saccharomyces cerevisiae can be a pathological organism and induce serious infections.Early recognition of the cause of peritonitis and controlling the source is critical to prevent complications.

Multidisciplinary survey on use of feeding tubes in head and neck cancer patients undergoing chemoradiotherapy in Germany-the SUFEETUBE project.

Data on enteral tube feeding in head and neck cancer (HNC) patients undergoing chemoradiotherapy vary considerably between German institutions. This survey aims to investigate the management of feeding tubes in an interdisciplinary context across Germany. Between December 2022 and May 2023, 70participants (42radiation oncologists, 12medical oncologists, 14head and neck surgeons, and 2physicians covering several specialties) responded to our web-based survey. In addition to the type of institution (university hospital, private practice, etc.), their age, and professional experience (in years), participants were asked several questions on the indication and institutional policy for tube placement and management (prophylactic/reactive nasogastric or gastrostomy tube). All questions were mandatory single- or multiple-choice questions, while additional comments were possible by email. Most participants were employed at auniversity hospital (n = 52; 74.3%) and came from aradiation oncology background (n = 42; 60%). Fifty-four contributors (77.1%) reported that no nutritional risk screening prior to chemoradiotherapy was routinely performed, and 71.4% (n = 50) stated that no standardized protocol was used at the institution to set the indication for tube placement. Generally, policies and methods of tube feeding vary considerably between the individual institutions and specialties. However, the majority (n = 56, 80%) recommended aprophylactic percutaneous enteral gastrostomy (PEG) tube to their patients before chemoradiotherapy. Still, there was no consistent trend regarding the approach for reactive tube feeding. The policies and methods of tube feeding vary considerably between the individual institutions and specialties in Germany. In the era of individualized medicine, uniform protocols are difficult to establish. However, abaseline nutritional risk screening could simplify decision-making in clinical practice.

"Novel Use of Endoscopic Ultrasound to Manage Complication of a Percutaneous Gastrostomy Tube Placement"

"Novel Use of Endoscopic Ultrasound to Manage Complication of a Percutaneous Gastrostomy Tube Placement"

An assessment of the relationship between body mass index and minor complications in percutaneous gastrostomy tubes.

The aim of our study was to determine if patients with obesity have different postoperative outcomes than their peers. A single-center retrospective review of all fluoroscopically-guided percutaneous gastrostomy tube, with 183 patients and 90 patients in the BAG and dilator groups, respectively. Patients were stratified, based on body mass index (BMI) percentile and for age. Demographic information and data on medical comorbidities and post-operative complications were collected. All analyses were conducted using Chi-square or Kruskal-Wallis testing. The median BMI was 26.6 kg/m2 with a standard deviation of 7.7. 106 (38.8%) patients were classified in the normal BMI category, 57 (20.9%) were overweight, and 50 (28.3%) were classified as obese. No major complications were reported in either group. 106 patients (38.8%) reported minor complications. The most common complication observed across both groups was procedural pain, with a higher incidence in the balloon group compared to the dilator group (17.5% vs. 12.2%). Dislodgement emerged as the second most common complication, occurring more frequently in the balloon group (12%) compared to the dilator group (6.7%). When considering weight categories, the overall rate of minor complications was highest among underweight patients (57.6%, P = 0.124). Both underweight and normal BMI patients showed a significantly higher incidence of tube dislodgement compared to other BMI categories (27.2% and 9.4%, respectively, P = 0.015). In a multivariable logistic regression, age was associated with an increased risk of minor complications (odds ratio [OR] 1.03, F [1.01, 1.05], P = 0.002). BAG had a greater OR for minor complication rate compared to dilator-assisted gastrostomy, although the difference was not statistically significant (OR 1.19, 95% confidence interval [0.69, 2.06]). Few studies have identified the relationship between BMI and complications related to gastrostomy tube placement. Our study highlights the importance of individualized care for patients across different BMI classes to minimize complications and improve patient outcomes.

FRI080 Post Bariatric Hypoglycemia And Pregnancy: Successful Utilization Of Remnant Stomach Gastrostomy Tube Placement In Severe Refractory Hypoglycemia After Roux-en-Y Gastric Bypass Surgery

Abstract Disclosure: S.S. Habbsa: None. A. Port: None. Introduction: Post bariatric hypoglycemia (PBH) can occur following Roux-En-Y Gastric Bypass (RYGB). Due to an exaggerated glucagon-like-peptide-1 (GLP-1) response from rapid nutrient transit to the distal bowel, patients with PBH exhibit endogenous hyperinsulinemic hypoglycemia following a carbohydrate load. Severe cases can result in significantly impaired quality of life (QoL), including syncope, seizures, and nutritional deficits from restricted intake. Recently, remnant stomach percutaneous endoscopy gastrostomy (PEG) tube placement has been reported in a handful of cases as a successful long-term strategy for RYGB-PBH refractory to nutritional and medical therapy. However, there are no known outcomes in pregnancy. Case: A 25-year-old female with a history of RYGB presented with increasingly severe and frequent PBH beginning 12 months after surgery. Mixed meal testing was consistent with prandial hypoglycemia (down to 20 mg/dL) with hyperinsulinemia (C-peptide 11 [0.80 - 3.10 ng/mL], Insulin 50 [<23 uIU/mL]). Ultrasound was negative for pancreatic anomalies. Dietary modification and medical therapy with acarbose, diazoxide, and liraglutide were unsuccessful. 3 years after RYGB, she required hospitalization for hypoglycemic seizures, and she underwent remnant stomach PEG tube placement. Oral intake was discontinued (except for protein for comfort) and substituted with 12-hour nocturnal feeds. Her PBH diminished, and she reported significant improvement in QoL. 6 years after PEG placement, the patient became pregnant. Working closely with a dietician, she increased caloric intake by 200-250 kcal/day in the second and third trimesters. Screening for gestational diabetes with oral glucose tolerance testing was deferred given risk of PBH exacerbation, and CGM was used instead for glycemic monitoring. Intolerance to overnight feeds was remedied using concentrated enteral formulas and incorporation of short daytime tube feed boluses. She delivered a healthy baby via elective C-section. During lactation, due to concern for food protein allergy, she was transitioned to a non-dairy non-soy-based feeding regimen. She returned to her pre-pregnancy weight and her sugars remained stable. Conclusion: This is the first case report documenting safe and effective use of remnant stomach enteral feeds for management of severe refractory PBH post RYGB during pregnancy and lactation. Pregnancy presents a unique situation in which increased carbohydrate intake is necessary to support fetal development; however, this can be life-threatening for patients with severe PBH. Remnant stomach PEG feeds utilize the original gut without need for surgical RYGB reversal, preventing rapid nutrient transit. Long-term reversal of PBH, sustained weight loss and customizable feeding regimens support the use of remnant PEG placement for severe RYGB-PBH in the appropriate patient. Presentation: Friday, June 16, 2023

S2625 Management of a Rare Complication of a Percutaneous Gastrostomy Tube Placement

S2625 Management of a Rare Complication of a Percutaneous Gastrostomy Tube Placement

A comparison of balloon-assisted versus dilator in percutaneous gastrostomy tube placement.

This study assesses the safety and efficacy of balloon-assisted gastrostomy (BAG) compared to conventional techniques using dilators. A single-center retrospective review of all fluoroscopically-guided percutaneous gastrostomy tube insertions from July 2017 to September 2020 was performed. Two hundred and seventy-three patients were included in this study, with 183 patients and 90 patients in the BAG and dilator groups, respectively. Fluoroscopy time, peak radiation dose, pain management, days to interventional radiology (IR) reconsultation, and post-operative complications (major and minor) for each procedure were reviewed to evaluate for statistical differences. There were shorter fluoroscopy times (5.13 min vs. 7.05 min, P = 0.059) and a significantly lower radiation use (Avg = 102.13 mGy vs. 146.98 mGy, P < 0.05) in the BAG group. The BAG group required significantly lower operating time (41 min vs. 48 min, P < 0.01) and received lower pain management (fentanyl 75 mcg and midazolam 1.5 mg, P < 0.001). The mean days to IR reconsultation for the BAG group was greater (29 days vs. 26 days, P = 0.38). The overall rate of minor complications (grades 1 and 2, according to the CIRSE classification system) was higher in the dilator group (39% vs. 35% in BAG group, P = 0.53). No major complications were reported in either group. BAG is a safe and efficient technique for percutaneous gastrostomy tube placement. BAG patients required significantly lesser radiation, OR time, post-operative pain management, and recorded lower postoperative complications compared to their counterparts in gastrostomies utilizing dilators.

Benefits of Early Utilization of Palliative Care Consultation in Trauma Patients.

To determine the effects of palliative care consultation if performed within 72 hours of admission on length of stay (LOS), mortality, and invasive procedures. Retrospective observational study. Single-center level 1 trauma center. Trauma patients, admitted to ICU with palliative care consultation. None. The ICU LOS was decreased in the early palliative care (EPC) group compared with the late palliative care (LPC) group, by 6 days versus 12 days, respectively. Similarly, the hospital LOS was also shorter in the EPC group by 8 days versus 17 days in the LPC group. In addition, the EPC group had lower rates of tracheostomy (4% vs 14%) and percutaneous gastrostomy tubes (4% vs 15%) compared with the LPC group. There was no difference in mortality or discharge disposition between patients in the EPC versus LPC groups. It is noteworthy that the patients who received EPC were slightly older, but there were no other significant differences in demographics. EPC is associated with fewer procedures and a shorter amount of time spent in the hospital, with no immediate effect on mortality. These outcomes are consistent with studies that show patients' preferences toward the end of life, which typically involve less time in the hospital and fewer invasive procedures.

Early Initiation of Tube Feedings After Inpatient Interventional Radiology Placed Percutaneous Gastrostomy Tubes: A Pilot Study

Early Initiation of Tube Feedings After Inpatient Interventional Radiology Placed Percutaneous Gastrostomy Tubes: A Pilot Study

Risk factors and natural history of bedside percutaneous endoscopic versus fluoroscopy-guided gastrostomy tubes in intensive care unit patients.

There is a paucity of literature comparing patients receiving bedside placed percutaneous endoscopic gastrostomy (PEG) versus fluoroscopic-guided percutaneous gastrostomy tubes (G-tube) in an intensive care unit (ICU) setting. This study aims to investigate and compare the natural history and complications associated with PEG versus fluoroscopic G-tube placement in ICU patients. All adult patients admitted in the ICU requiring feeding tube placement at our center from 1/1/2017 to 1/1/2022 with at least 12-month follow up were identified through retrospective chart review. Adjusting for patient comorbidities, hospital factors, and indications for enteral access, a 1-to-2 propensity score matched Cox proportional-hazards model was fitted to evaluate the treatment effect of bedside PEG tube placement versus G-tube placement on patient 1-year complication, readmission, and death rates. Major complications were defined as those requiring operative or procedural intervention. This study included 740 patients, with 178 bedside PEG and 562 fluoroscopic G-tube placements. The overall rate of complication was 22.3% (13% PEG, 25.2% G-tube, P = 0.003). The major complication rate was 11.2% (8.5% PEG, 12.1% G-tube, P = 0.09). Most common complications were tube dysfunction (16.7% PEG; 39.4% G-tube; P = 0.04) and dislodgement (58.3% PEG; 40.8% G-tube). After propensity score matching, G-tube recipients had significantly increased risk for all-cause (HR 2.7, 95% CI 1.56-4.87, P < 0.001) and major complications (HR 2.11, 95% CI 1.05-4.23, P = 0.035). There were no significant differences in 1-year rates of readmission (HR 0.90, 95% CI 0.58-1.38, P = 0.62) or death (HR 1.00, 95% CI 0.70-1.44, P = 0.7). The overall rate of complications for ICU patients requiring feeding tube in our cohort was 22.3%. ICU patients receiving fluoroscopic-guided percutaneous gastrostomy tube placement had significantly elevated risk of 1-year all-cause and major complications compared to those undergoing bedside PEG.

Percutaneous Transesophageal Gastrostomy: Procedural Technique and Outcomes

PurposeTo demonstrate the safety and effectiveness of percutaneous transesophageal gastrostomy (PTEG) as a palliative option in patients with malignant bowel obstructions (MBOs), and provide a comprehensive review of PTEG indications, placement technique, and short- and long-term outcomes. Materials and MethodsThirty-eight consecutive patients who underwent a PTEG procedure attempt from 2014 to 2022 were included in this analysis. Clinical indications, method of placement, technical and clinical success, adverse events, including procedure-related mortality, and effectiveness were assessed. Technical success was defined as placement of a PTEG. Clinical success was defined as improvement in clinical symptoms following PTEG placement. ResultsOf the 38 patients who underwent PTEG, 19 (50%) were men and 19 (50%) were women (median age, 58 years; range, 21–75 years). Three (8%) PTEG placements were performed with the patients under moderate sedation, whereas the remainder (92%) were performed with the patients under general anesthesia. Technical success was achieved in 35 of the 38 (92%) patients. The mean catheter duration was 61 days (median, 29 days; range, 1–562 days), with 5 of the 35 patients requiring tube exchanges after initial placement. Moreover, 7 of the 35 patients with successful PTEG placement experienced an adverse event, including 1 case of non–procedure-related mortality. All patients with successful PTEG placement experienced improvement in clinical symptoms. ConclusionsPTEG is an effective and safe option for patients with contraindications to traditional percutaneous gastrostomy tube placement in the setting of MBO. PTEG is an effective means of providing palliation and improving the quality of life.

Nutrition and head-neck cancer: A prospective observational study in patients with head neck cancer receiving adjuvant/definitive radiotherapy/chemoradiotherapy.

e18784 Background: Head-Neck cancers are at higher risk of malnutrition due to their disease or its treatment which can cause structural changes to the oral cavity and prevent effective nutrition. Malnutrition is assessed by anthropometric measurements. Skeletal muscle strength is also a marker of nutrition. The present study aimed to study the correlation between nutrition, muscle strength and acute toxicities in patients with head and neck squamous carcinoma receiving concurrent chemoradiotherapy or radiotherapy alone. Methods: A prospective observational study was conducted at Deenanath Mangeshkar Hospital, Pune, India in patients with nonmetastatic head neck squamous cancers planned for definitive or adjuvant chemo-radiotherapy. Nutritional status was assessed at baseline, end of treatment and after 3months of treatment by mid-arm circumference, weight, height and body mass index. Muscle strength was assessed by Jamar’s handgrip dynamometer. Results: A total of 103 patients (85 males and 18 females) participated in the study between February 2020 and February 2021. Four patients had to be withdrawn before initiating treatment, 99 patients completed the planned course of treatment. Mean age was 54.4 years. Postoperative chemoradiotherapy was give to 37 patients, 22 received definitive chemoradiotherapy, 33 received postoperative radiotherapy alone and 7 patients received definitive radiotherapy. A statistically significant reduction in all nutritional parameters during treatment and at 3 months after completion of treatment was seen. Mucositis and odynophagia were the commonest toxicities. Nasogastric or percutaneous gastrostomy tube was inserted in 25 patients. Seven patients required hospitalisation for toxicities. There were no treatment related deaths. Conclusions: Head and neck cancer patients undergoing concurrent chemoradiation or radiation are at significantly higher risk of malnutrition. Loss of muscle strength correlates with treatment related acute toxicity. [Table: see text]

Rapid exchange of a percutaneous gastrostomy tube during an early episode of COVID-19

Rapid exchange of a percutaneous gastrostomy tube during an early episode of COVID-19

Clinical Trajectories in Patients with Severe Acute Brain Injury Requiring Mechanical Ventilation: A Descriptive Analysis of a Single-Center Prospective Observational Cohort Study (P5-7.005)

<h3>Objective:</h3> To describe outcomes for patients with severe acute brain injury (SABI) who require mechanical ventilation (MV). <h3>Background:</h3> Patients with SABI often require MV due to impaired consciousness and insufficient airway protection, reflecting a substantial neurological injury. Outcomes for this high-acuity population have been insufficiently explored. <h3>Design/Methods:</h3> In this single-center prospective, observational cohort study at a level-1 trauma and comprehensive stroke center, we included consecutive adult patients with SABI, including traumatic brain injury (TBI), spontaneous intracranial hemorrhage (sICH), acute ischemic stroke (AIS), and subarachnoid hemorrhage (SAH), who required MV on admission between September-November 2021. We assessed in-hospital and 6–12 months mortality, tracheostomy and percutaneous gastrostomy tube (PEG) placement, and Extended Glasgow Outcome Score (GOS-E) at 6–12 months. <h3>Results:</h3> Overall, 90 patients (age 55 [SD 19], 73% male; median Glasgow Coma Scale on admission 7 [IQR 3,11]; 50% TBI, 20% sICH, 18% AIS, 12% SAH) were included. Median duration of MV was 2 days (IQR 1,7), with 40% requiring MV for £ 24 hours (G1), 37% 1–7 days (G2), and 23% &gt;7 days (G3). In-hospital mortality was 47% (n=42), 79% (33/42) died after withdrawal of life-sustaining treatments (30% £24 hours, 24% 1–7 days, 45% &gt;7 days). One third of survivors (30%, n=13) underwent PEG, 16% (n=7) tracheostomy. At 6–12 months, 51% (n=46) had died (51% TBI, 67% sICH, 44% AIS, 36% SAH; 44% G1, 55% G2, 57% G3); 57% of survivors (64% TBI, 50% sICH, 33% AIS, 71% SAH; 60% G1, 67% G2, 22% G3) had a GOS-E of 5–8. Among survivors who underwent PEG and tracheostomy, 54% and 29% had a GOS-E 5–8; all survivors who initially underwent tracheostomy were decannulated at 6–12 months. <h3>Conclusions:</h3> Mortality and long-term disability in patients with SABI who required MV were high and varied based on SABI subtype and duration of MV. <b>Disclosure:</b> Ms. Smith has nothing to disclose. Ms. JAMES has nothing to disclose. Dr. Matin has nothing to disclose. Dr. Sarhadi has nothing to disclose. Dr. Town has nothing to disclose. The institution of Dr. Creutzfeldt has received research support from NINDS. The institution of Dr. Creutzfeldt has received research support from NINR. Chiara Robba has nothing to disclose. Giuseppe Citerio has nothing to disclose. Dr. Lele has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for LifeCenter Northwest . Dr. Wahlster has nothing to disclose.

Hospice and Palliative Care for Patients in the Intensive Care Unit: Current Status in Countries Other than Korea.

Although most patients prefer dying at home, patients whose condition rapidly becomes critical need care in the intensive care unit (ICU), and it is rare for them to die at home with their families. Therefore, interest in hospice and palliative care for patients in the ICU is increasing. Hospice and palliative care (PC) is necessary for all patients with life-threatening diseases. The following patients need palliative care in the ICU: patients with chronic critical illnesses who need tracheostomy, percutaneous gastrostomy tube, and extracorporeal life support; patients aged 80 years or older; stage 4 cancer patients; patients with specific acute diseases with a poor prognosis (e.g., anoxic brain injury and intracerebral hemorrhage requiring mechanical ventilation); and patients for whom the attending physician expects a poor prognosis. There are two PC models-a consultative model and an integrative model-in the ICU setting. Since these two models have advantages and disadvantages, it is necessary to apply the model that best fits each hospital's circumstances. Furthermore, interdisciplinary decision-making between the ICU care team and PC specialists should be strengthened to increase the provision of hospice and palliative care services for patients expected to have poor outcomes and their families.

Abstract TP74: Reducing Complications From Gastrostomy Tube Insertion In Stroke Patients - Quality Improvement Project At An Academic Tertiary Hospital

Introduction: Percutaneous gastrostomy tubes are frequently required for patients with strokes due to dysphagia, malnutrition, and intestinal dysmotility. Though generally well tolerated, delayed detection of complications following percutaneous gastrostomy tube insertion (including dislodgement, infection and bleeding) can lead to increased morbidity and mortality. Methods: At a single academic tertiary hospital, a standardized protocol was instituted (September 2021) to enhance early detection and prevention of feeding tube complications on the neurology service, consisting predominantly of stroke patients. The protocol comprised of: 1) consistent documentation of feeding tube insertion by proceduralists, 2) universal abdominal binder application, 3) nursing driven delirium screening, 4) post procedural nursing assessment for high-risk feeding tube site changes, and 5) an escalation algorithm to address early complications. We compared rates of complications pre- (July 2020 - August 2021, 13 months) and post- (September 2021 - June 2022, 10 months) protocol implementation. Results: A total of 103 gastrostomy tube insertions were reviewed (64 pre and 39 post protocol implementation). Overall complication rates decreased from 12.5% (N = 8 of 64; 3 dislodgements, 3 infections, 2 insertion site bleeding) to 2.5% (N = 1 of 39; 1 dislodgment) following the intervention. Mortality from complications decreased from 1.6% to 0%. Conclusion: Complication rates of percutaneous gastrostomy tube placement may be reduced through implementation of standardized protocols on inpatient stroke patients. Further studies are warranted to assess its long-term effects and viability in other specialty services.

Cone-beam computed tomography-assisted percutaneous gastrostomy tube insertion in children with challenging anatomy.

Percutaneous radiological gastrostomy tube insertion is a common procedure in children. An approach using ultrasound and fluoroscopy may not be feasible in patients with challenging anatomy; therefore, advanced techniques or other imaging modalities may be required. To describe our experience using cone-beam computed tomography (CT)-assisted percutaneous gastrostomy insertion in pediatric patients with challenging anatomy. A retrospective review was performed in children who underwent cone-beam CT-assisted percutaneous radiologic gastrostomy between January 2015 and July 2019. Indications, technique, outcomes, complications, and radiation dose (reference-point air kerma, air kerma area product) were assessed through chart and imaging review. Descriptive statistics only were used. Twenty-seven procedures were attempted in 26 patients. Reasons for utilizing cone-beam CT guidance were high-positioned stomach (n = 10), interposing bowel loops and liver (n = 19), omphalocele (n = 1), severe scoliosis (n = 1), and ventriculoperitoneal shunt (n = 1). Technical success was 85% (23/27). Mean procedure time was 96min (range 50-131min). No safe access route into the stomach was encountered in four patients; three were referred for surgical gastrostomy and one had a successful re-attempt. Radiation dose data was obtained from 19 procedures (17 successful) with a total dose in successful procedures ranging from 8.1 to 63.6mGy (average 26.2mGy, median 24.9mGy). The number of cone-beam CT acquisitions per procedure ranged from 1 to 4. Major complication frequency was 11% (3/27) (bleeding, peritonitis, and aspiration pneumonia); minor complication frequency was 3.7% (1/27). This study shows that cone-beam CT guidance can be useful for assisting percutaneous radiologic gastrostomy in children with challenging anatomy.

Regional Anesthesia as an Alternative to Moderate Sedation for Perioperative Pain Control for Percutaneous Gastrostomy Tube Placement

Percutaneous gastrostomy tube placement is typically performed under moderate sedation. However, some patients are not ideal candidates for moderate sedation because of respiratory compromise, difficult airways, or other factors. The purpose of this study was to evaluate regional anesthesia as an alternative to moderate sedation. A retrospective review of patients who underwent percutaneous gastrostomy tube placement between March 2014 and September 2020 was performed. Data on patient demographics, anesthesia type, pain scores, and opiate usage were collected. A total of 189 patients were included in the study; 35 (18.5%) received regional anesthesia and 154 received moderate sedation. Patients in the regional anesthesia group tolerated the procedure well, with lower mean immediate postprocedural and maximal pain scores of 0.7 vs 2.2 (P = .011) and 4.3 vs 6.5 (P = .003), respectively. Regional anesthesia is effective at controlling perioperative pain and is an alternative with a low complication rate for patients who cannot tolerate moderate sedation.

The Abdominal Wall Factor: Impact of Surgical Technique in Feeding Access in the Obese Population

INTRODUCTION: Surgical feeding access is necessary in long-term care of patients. Although high complication rates have been documented, modification of operative technique to minimize complication has not been described. We sought to document complication rate of surgical feeding access and identify contributing factors. We hypothesized that in obese patients, laparoscopic gastrostomy tubes (LapG) would confer fewer complications than percutaneous gastrostomy tubes (PEG). METHODS: We conducted a retrospective review of all surgical feeding access cases performed by the ACS service from September 1, 2012, to June 30, 2021. Patient demographics, hospitalization metrics, and outcomes were compared. RESULTS: Feeding access accounted for 14% of cases performed by the ACS service and represented 21% of 30-day mortalities. There were 133 complications associated with these procedures, with no difference between trauma and emergency general surgery populations (6.8% vs 5.7%, p = 0.44). Patients with a BMI >30 kg/m2 had a higher incidence of complications including tube migration requiring operation (4.6% vs 2.5%, p = 0.03). This association held true in PEG patients (4.8% vs 2.2%, p = 0.03), but not in LapG patients (2.4% vs 2.6%, p = 0.87). CONCLUSION: Complications from feeding access has been studied, but this is the first to determine thresholds for changes in operative approach. ACS surgeons should consider LapG over PEG to minimize complication risk in patients with BMI >30 kg/m2. We must tailor our operative technique to the patient populations we care for instead of using a “one-size fits all” approach. If surgeons are tasked feeding access procedures to facilitate patient throughput, we must mitigate potential complications instead of accepting their inevitability.

S2601 Gastroepiploic Pseudoaneurysm: A Shocking Complication of PEG Tube Placement

Introduction: Percutaneous gastrostomy (PEG) tubes are commonly used for enteric feeds and medication administration. While considered safe and routine, PEG tube placement is not without its complications. Here we present a rare case of hemorrhagic shock secondary to traumatic pseudoaneurysm formation after PEG tube placement. Case Description/Methods: A 52-year-old male with atrial fibrillation on apixaban and a recent stroke with PEG tube placement 1 month prior to arrival presented to the hospital with multiple episodes of hematemesis. CT angiography of the abdomen was unremarkable and negative for signs of active bleeding. Antiplatelets were held and anticoagulation was reversed with prothrombin complex concentrate. Esophagogastroduodenoscopy showed signs of erosive esophagitis with proper PEG tube placement but without signs of active bleeding. Hematemesis re-occurred less than 24 hours after anticoagulation was resumed, with subsequent development of hemorrhagic shock. Visceral arteriogram revealed a right gastroepiploic artery pseudoaneurysm, which likely developed from trauma during recent PEG placement. The patient stabilized after coil embolization and blood transfusion. He was then safely resumed on anticoagulation without further bleeding. Discussion: GI bleeding associated with PEG placement occurs in 0.6-1.2% of cases, and usually occurs at the gastrostomy tract or from gastric ulceration. Bleeding related to pseudoaneurysm formation is exceedingly rare with only a handful of case reports documenting such occurrence. While contrast enhanced imaging may aid in the diagnosis, small pseudoaneurysms may not be detected with noninvasive angiographic studies (as was the case here). Given this potentially life-threatening complication, clinicians must consider pseudoaneurysm formation as part of their differential for GI bleed after recent PEG placement especially if endoscopic evaluation is unrevealing.