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'''Displaced Gastrostomy Tube'''
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==Background:==
==Background==
The percutaneous gastrostomy tube (PEG) is commonly indicated in:
*patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing
*oropharyngeal or esophageal obstruction
*major facial trauma


A PEG may also be placed for:
*The percutaneous gastrostomy tube (PEG) is commonly indicated in:
*passive gastric decompression
**Patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing
*mechanical apposition of the stomach to the abdominal wall to prevent hiatal herniation.  
**Oropharyngeal or esophageal obstruction
**Major facial trauma
**Passive gastric decompression
**Mechanical apposition of the stomach to the abdominal wall to prevent hiatal herniation
*Most PEGs are 18F to 28F and may be used for 12-24mo
*Displacement is estimated to occur in 1.6-20% of patients with PEG tubes




Most PEGs are 18F to 28F and may be used for 12-24mo.
===Anatomy===


The G-tube creates a connection via a hollow tube, from the gastric lumen, through the gastric wall and peritoneum, and through the abdominal wall


General complications include:
*wound infection
*necrotizing fasciitis
*peritonitis
*aspiration +/- pneumonia
*leaks
*dislodgment
*bowel perforation
*enteric fistulas
*bleeding
*gastric outlet obstruction
*small bowel obstruction
*ileus
*esophageal or gastric perforation
*buried bumper syndrome
*fistula
*gastric herniation through the stoma


Displacement is estimated to occur in 1.6-20% of patients with PEG tubes.
==Clinical Features==


==Anatomy:==
*G-tube fully removed or partially removed with deflated balloon exposed
The G-tube creates a connection via a hollow tube, from the gastric lumen, through the gastric wall and peritoneum, and through the abdominal wall.


==Management of the Displaced Tube:==
Within 2-4 weeks of insertion: do not attempt to replace the tube, as this many not represent sufficient time for full epithelialization of the percutaneous tract. Instead, urgent general surgical, gastroenterology, or radiology consult is recommended.


If the PEG tube has been in place for more than 2-4 weeks, reinsertion should be attempted as soon as possible, as mature stomas close rapidly (within minutes to hours). 
==Differential Diagnosis==
*Replacement tubes should be of the same size as the initial tube.
*If the original size is unknown, a 16 or 18 French G tube or a Foley catheter may generally be used.


'''To replace a tube''':
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{{DDX G-tube}}
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1. Deflate the balloon


2. Lubricate the tube with lidocaine jelly
==Evaluation==


3. Reinsert the tube along the tract. '''Never force the tube'''. Forcing the tube may separate the stomach from the abdominal wall and result in intraperitoneal placement of the G tube.
*Clinical diagnosis


4. Inflate the ballon with NS


5. Apply gentle traction to position the balloon against the gastric wall
==Management==


6. Confirm positioning. Options include:
*Inject 20-30mL of water-soluble contrast [Gastrografin], then obtain an upright abdominal XR.
*Inject of 10cc NS through the tube under direct ultrasound visualization of the stomach.
*Check tube fluid: gastric fluid pH is normally <4.


==Disposition:==
===Within 2-4 Weeks of Insertion===
Tubes in place less than 2-4 weeks need urgent surgical, gastroenterology, or radiology consult.
 
*'''''Do not attempt to replace the tube'''''
*May not represent sufficient time for full epithelialization of the percutaneous tract
*Efforts at replacement may result in intra-peritoneal tube
*Urgent general surgical, gastroenterology, or radiology consult is recommended
*Admit for IV antibiotics and monitor for peritonitis
 
 
===More Than 2-4 Weeks===
 
*Reinsertion should be attempted as soon as possible
**Mature stomas close rapidly (within minutes to hours)
*Replacement tubes should be of the same size as the initial tube
*If the original size is unknown, a 16 or 18 French G tube or a Foley catheter may generally be used
 
===Replacing a G-Tube===
 
#Deflate the balloon
#Lubricate the tube with lidocaine jelly
#Position the patient reclined in bed to decrease abdominal pressure and relax abdominal wall musculature
#Reinsert the tube along the tract
#*'''Never force the tube'''
#*Forcing the tube may separate the stomach from the abdominal wall and result in intraperitoneal placement of the G tube
#*If unable to replace g-tube, attempt one size smaller or a foley catheter
#Inflate the balloon with NS (amount written in milliliters on the port)
#Apply gentle traction to position the balloon against the gastric wall
#Adjust the external bolster against the skin with approximately 1cm of mobility and secure with tape and gauze
#Not recommended to place gauze between external bolster and skin
#Confirm positioning. Options include:
#*Inject 20-30mL of water-soluble contrast [Gastrografin], then obtain an upright abdominal XR
#*Inject of 10cc NS through the tube under direct ultrasound visualization of the stomach
#*Check tube fluid: gastric fluid pH is normally <4
 
 
==Disposition==
 
*Tubes in place less than 2-4 weeks need urgent surgical, gastroenterology, or radiology consult
*Otherwise, tubes may be reinserted as described above, with urgent surgical, gastroenterology, or radiology consult if the tube is not replaced easily
 
 
==External Links==
 
*[https://www.youtube.com/watch?v=1Ue63A2ULUI YouTube - Gtube Replacement]


Otherwise, tubes may be reinserted as described above, with urgent surgical, gastroenterology, or radiology consult if the tube is not replaced easily.


==See Also==
==See Also==
https://wikem.org/wiki/Clogged_feeding_tube


==References==
*[[Special:MyLanguage/G-tube complications|G-tube complications]]
<Bistrian B.R., Hoffer L, Driscoll D.F. (2015). Enteral and Parenteral Nutrition Therapy. In Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J (Eds),Harrison's Principles of Internal Medicine, 19e. Retrieved January 23, 2016 fromhttp://accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=1130&Sectionid=63653665./>


<Corbett* S.A. (2014). Systemic Response to Injury and Metabolic Support. InBrunicardi F, Andersen D.K., Billiar T.R., Dunn D.L., Hunter J.G., Matthews J.B., Pollock R.E. (Eds), Schwartz's Principles of Surgery, 10e. Retrieved January 23, 2016 fromhttp://accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=980&Sectionid=59610843./>


<Cruz E.S., Stolzenberg D, Moon D (2015). Medical Emergencies in Rehabilitation Medicine. In Maitin I.B., Cruz E (Eds), CURRENT Diagnosis & Treatment: Physical Medicine & Rehabilitation. Retrieved January 23, 2016 fromhttp://accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=1180&Sectionid=70382621./>
==References==


<DeLegge, M.H. Gastrostomy tubes: Complications and their management. UpToDate. Accessed: 01/23/16. Last updated: Apr 15, 2015. https://www-uptodate-com.foyer.swmed.edu/contents/gastrostomy-tubes-complications-and-their-management?source=search_result&search=gastrostomy+tube&selectedTitle=2~142/>
<references/>


<Witting M.D. (2016). Gastrointestinal Procedures and Devices. In Tintinalli J.E., Stapczynski J, Ma O, Yealy D.M., Meckler G.D., Cline D.M. (Eds), Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. Retrieved January 23, 2016 fromhttp://accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=1658&Sectionid=109433184./>
[[Category:GI]][[Category:Procedures]]
[[Category:Surgery]]
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Revisión actual - 22:48 4 ene 2026


Background

  • The percutaneous gastrostomy tube (PEG) is commonly indicated in:
    • Patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing
    • Oropharyngeal or esophageal obstruction
    • Major facial trauma
    • Passive gastric decompression
    • Mechanical apposition of the stomach to the abdominal wall to prevent hiatal herniation
  • Most PEGs are 18F to 28F and may be used for 12-24mo
  • Displacement is estimated to occur in 1.6-20% of patients with PEG tubes


Anatomy

The G-tube creates a connection via a hollow tube, from the gastric lumen, through the gastric wall and peritoneum, and through the abdominal wall


Clinical Features

  • G-tube fully removed or partially removed with deflated balloon exposed


Differential Diagnosis

G-tube complications


Evaluation

  • Clinical diagnosis


Management

Within 2-4 Weeks of Insertion

  • Do not attempt to replace the tube
  • May not represent sufficient time for full epithelialization of the percutaneous tract
  • Efforts at replacement may result in intra-peritoneal tube
  • Urgent general surgical, gastroenterology, or radiology consult is recommended
  • Admit for IV antibiotics and monitor for peritonitis


More Than 2-4 Weeks

  • Reinsertion should be attempted as soon as possible
    • Mature stomas close rapidly (within minutes to hours)
  • Replacement tubes should be of the same size as the initial tube
  • If the original size is unknown, a 16 or 18 French G tube or a Foley catheter may generally be used

Replacing a G-Tube

  1. Deflate the balloon
  2. Lubricate the tube with lidocaine jelly
  3. Position the patient reclined in bed to decrease abdominal pressure and relax abdominal wall musculature
  4. Reinsert the tube along the tract
    • Never force the tube
    • Forcing the tube may separate the stomach from the abdominal wall and result in intraperitoneal placement of the G tube
    • If unable to replace g-tube, attempt one size smaller or a foley catheter
  5. Inflate the balloon with NS (amount written in milliliters on the port)
  6. Apply gentle traction to position the balloon against the gastric wall
  7. Adjust the external bolster against the skin with approximately 1cm of mobility and secure with tape and gauze
  8. Not recommended to place gauze between external bolster and skin
  9. Confirm positioning. Options include:
    • Inject 20-30mL of water-soluble contrast [Gastrografin], then obtain an upright abdominal XR
    • Inject of 10cc NS through the tube under direct ultrasound visualization of the stomach
    • Check tube fluid: gastric fluid pH is normally <4


Disposition

  • Tubes in place less than 2-4 weeks need urgent surgical, gastroenterology, or radiology consult
  • Otherwise, tubes may be reinserted as described above, with urgent surgical, gastroenterology, or radiology consult if the tube is not replaced easily


External Links


See Also


References

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