Management of early dislodgment of percutaneous endoscopic gastrostomy tubes

One of the most serious complications of percutaneous endoscopic gastrostomy (PEG) is premature removal of the gastrostomy tube. In an attempt to clarify the optimal therapy of this complication, the records of 197 patients undergoing PEG were reviewed. Six patients whose PEG tubes were removed 2.9 +/- 1.3 days after placement were identified; only one patient required an emergent operation. The patients managed nonoperatively were treated by immediate replacement of tubes through the tracts (two patients), observation prior to repeat PEG (two), and delayed laparoscopic gastrostomy (one). Nonoperative management is feasible in the majority of patients suffering this complication. When an operation is indicated because of suspected intraperitoneal spillage, laparoscopy allows wide visualization and irrigation of the peritoneal cavity, closure of the gastrotomy, and placement of new enteral access while avoiding the morbidity associated with laparotomy in these often-debilitated patients.