TITLE

A SIMPLE AND SAFE METHOD OF TRANSCUTANEOUS GASTROSTOMY REPLACEMENT

AUTHOR(S)
Frenz, M.B.; Siuda, G.; McIntyre, A.S.; Travis, S.P.L.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA97
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Introduction: The replacement of gastrostomy (PEG) feeding tubes often requires endoscopic procedures as the fistula closes soon after the accidental or elective removal of the PEG. Transcutaneous replacement of PEG tubes often leads to reduction in PEG size because of contraction of the fistula tract. Aim: To assess the use and safety of a guide wire and vascular dilators for transcutaneous PEG replacement. Methods: Patients referred for either elective PEG replacement or re-insertion of accidentally removed PEGs received the new balloon PEG (MIC-Key Peg, Vygon UK, in 11 cases and Corflow, Merck UK in one case) using the transcutaneous approach. The gastrostomy fistula was dilated with vascular dilators after a standard ERCP guide wire was passed through the fistula. The replacement PEG was inserted over the guide wire and the position checked by aspiration of gastric contents. Results: A total of 12 PEGs were replaced in 8 patients. In 9 episodes the PEG had been accidentally removed and patients presented after a delay of 16-24 hours. In 3 cases the PEG had to be replaced because of malfunction and the old PEG was removed using the cut and push technique. Sedation was only used in one patient. The gastrostomy fistula was dilated to 2 Fr larger than the replacement PEG. In 9 cases the size of the replacement PEG was identical to that of the old PEG (14 Fr in 8 patients and 10 Fr in one patient). In two cases the replacement PEG was smaller than the original PEG (20 Fr to 14 Fr and 18 Fr to 16 Fr). In one case the replacement PEG was larger than the original PEG (9 Fr to 12 Fr). All patients tolerated the procedure well and had no complications except minor bleeding during dilatation, which was self-limiting. In 8 of the 12 patients the procedure was carried out as an outpatient procedure. Comments: This technique of PEG replacement appears safe and well tolerated by patients. It reduces the need for repeat endoscopic procedures and sedation in most cases....
ACCESSION #
9747942

 

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