Endoscopic Removal Of Percutaneous Endoscopic Gastrostomy (PEG) Tube Bumper

摘要

We report about a patient presenting with a complication of a Percutaneous Endoscopic Gastrostomy (PEG) tube. Case Report A 65 year old lady with a previous history of surgical resection of a benign brain tumour in the posterior fossa with subsequent insertion of a silicone PEG tube (Kimberly-Clark? MIC-PEG PUSH) and trachestomy (size 7) for poor brain stem function, came in for a replacement of her blocked PEG tube 13 months later. In the interim period, her tracheostomy had been changed to a smaller fenestrated tube (size 5). During removal of the PEG tube, the bumper portion failed to be extracted externally. The external tube was then divided and the bumper and remaining tube displaced into the stomach. Under local anaesthesia, oesophagogastroduodenoscopy (OGD) with a snare failed to remove the bumper past the level of the cricopharyngeus. She was taken to theatre the following day and under general anaesthesia the scope was re-passed. However, it was still not possible to easily extract the bumper past the cricopharyngeus. The tracheostomy cuff was then deflated, and using a combination of rigid and flexible oesophagoscopy, the bumper was extracted with more ease. Palpation of the bumper showed that its integrity had changed (see figure).