What are the possible complications of gastrostomy tube replacement?

Updated: May 26, 2020
  • Author: Erik D Schraga, MD; Chief Editor: Vikram Kate, MBBS, MS, PhD, FRCS, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

The most dreaded complication of G-tube replacement is misplacement of the tube into the peritoneal cavity. This is far more common in recently placed tubes but has been reported in patients with mature tracts (>30 days). [19] Starting tube feeds into the peritoneum often leads to serious morbidity and mortality. This complication can be avoided by obtaining a verification study before using the tube.

Malpositioning of a replaced G-tube causing gastric outlet obstruction has been reported after an accidental removal of a G-tube. [20] The patient presented with epigastric pain and refractory vomiting, and computed tomography showed that the tip of the G-tube was extending into the proximal duodenum, leading to gastric outlet obstruction. After the tube was retracted several centimeters proximally, the symptoms resolved.

As with most procedures, bleeding is a possible complication. A small amount of bleeding can be expected with G-tube replacement. Large amounts of bleeding should prompt consultation with a specialist.

Wound infection with manipulation at the site of insertion is possible. [21]  If patient has granulation tissue around the previously placed G-tube, the infection may be exacerbated. [22]

External bolsters that are sutured to the skin too tightly can lead to a short stoma and abscess formation. However, inappropriately secured tubes may result in internal migration and gastric outlet obstruction. [23]

Overly vigorous replacement in a narrowed ostomy can separate the stomach from the external stoma and cause viscous leak and peritonitis. Gentle placement is, thus, paramount.

Buried bumper syndrome is a potentially life-threatening condition that may follow percutaneous endoscopic gastrostomy (PEG) and often warrants removal and reinsertion of the G-tube by endoscopic or laparoscopic means. [24] However, cases in which the buried bumper was removed by external traction alone through two radial millimeter skin incisions have been reported. [25]

In rare instances, PEG tube rupture can occur with sudden-onset abdominal pain following long-standing use of PEG. In a case report by al Halabi et al, [26] separation of the PEG tube into two fragments was found; this was managed conservatively with removal of the fragments, advancement of a guide wire through the distal fragment, and placement of a new PEG.


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