GASTROENTEROLOGY ARTICLE OF THE WEEK
April 29, 2004
McClave SA, Chang WK. Complications of enteral access. Gastroint Endosc 2003;2003;58:739-51.
1. Endoscopically-placed enteric tubes:
a. proximal migration occurs in about 12% to 16% of patients
b. checking residual gastric volume decreases the incidence of enteral tube
clogging
c. risk of aspiration related to long-term nasoenteric tube is about 25%-40%
d. risk of aspiration is not decreased by delivering the feeding in the small bowel
rather than the stomach
e. selective gut decontamination to reduce risk of aspiration pneumonia is recommended.
2. Interventions that may help reduce leakage at a leaking PEG site include
a. Use of acid reducing therapy
b. elimination of corrosive agent administration (i.e. vitamin C)
c. applying side torsion to the tube
d. use of antifungal cream and zinc oxide cream around the site
e. cleaning the area with hydrogen peroxide
True or False:
3. If accidental removal of a PEG tube 3 days after placement is witnessed, a second PEG tube can be inserted endoscopically neart the initial site
4. Migration of the jejunal tube to the stomach in a PEG-J occurs in about 27% to 42% of cases.
5. The most common complication after PEG placement is PEG-site infection
6. Pneumoperitoneum found on routine X-ray exam 2 hours after a PEG should prompt a delay in starting PEG feeding beyond the usual 4 hours.
7. Patients who remove a PEG tube less than 5 days after placement should undergo exploratory laparotomy immediately to seal the gastric perforation