Intestinal passage of the PEG end-piece: is it safe?

• Published in: Journal of gastroenterology and hepatology Vol. 9; no. 3; p. 311
• Main Authors: Coventry, B J, Karatassas, A, Gower, L, Wilson, P
• Format: Journal Article
• Language: English
• Published: Australia 01.05.1994
• Subjects: Aged; Aged, 80 and over; Female; Gastroscopy; Gastrostomy - adverse effects; Gastrostomy - instrumentation; Gastrostomy - methods; Humans; Intestinal Obstruction - etiology; Intestinal Perforation - etiology; Intestine, Small; Male
• ISSN: 0815-9319
• DOI: 10.1111/j.1440-1746.1994.tb01732.x

Two rare but life-threatening complications of percutaneous endoscopic gastrostomy (PEG) are reported: small bowel perforation and obstruction. Both resulted from impaction of the PEG end-piece after separation at skin level. Review of the literature revealed very few complications from intestinal passage of PEG end-pieces. The free intragastric PEG end-piece routinely passes through the gastrointestinal tract in most cases. One of these two cases was drawn from a series of 100 patients with intentional intestinal passage of PEG end-pieces to give a severe complication rate of 1%. A case can be made for routine endoscopic per-oral removal of PEG end-pieces in the elective setting, but this is more costly and not without hazard. Previous laparotomy and/or known adhesions is a relative indication for endoscopic retrieval of the PEG end-piece. Oesophageal disease or intolerance of endoscopy is a relative indication for intestinal passage. Close clinical follow up is recommended to ensure that the PEG end-piece has passed per-rectum. If the PEG end-piece has not passed and is shown in the small bowel on plain X-ray at approximately 3 weeks after separation then lodgement has probably occurred and early operative intervention is warranted.