Gastrostomy tubes: Complications and their management
- Mark H DeLegge, MD, FACG, AGAF
Mark H DeLegge, MD, FACG, AGAF
- Professor of Medicine
- Medical University of South Carolina
- Section Editors
- John R Saltzman, MD, FACP, FACG, FASGE, AGAF
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
- Section Editor — Therapeutic and Diagnostic Endoscopy
- Professor of Medicine
- Harvard Medical School
- Timothy O Lipman, MD
Timothy O Lipman, MD
- Section Editor — Nutrition
- GI-Hepatology-Nutrition Section
- Washington DC Veterans Affairs Medical Center
Gastrostomy tubes may be placed endoscopically, surgically, or radiologically. Many of the complications seen with the various placement techniques are similar with similar approaches to management.
This topic will review the management of complications related to gastrostomy tube placement, with a focus on percutaneous endoscopic gastrostomy tubes. The indications for gastrostomy tubes, the placement of gastrostomy tubes, the routine care of gastrostomy tubes, and the management of dysfunctioning gastrostomy tubes are discussed separately. (See "Gastrostomy tubes: Uses, patient selection, and efficacy in adults" and "Gastrostomy tubes: Placement and routine care".)
INCIDENCE OF COMPLICATIONS
Complications of gastrostomy tube placement may be minor (wound infection, minor bleeding) or major (necrotizing fasciitis, colocutaneous fistula). Most complications are minor. The reported rates of complications following percutaneous endoscopic gastrostomy (PEG) tube placement vary from 16 to 70 percent [1-5]. The variable frequency of complications observed in reports in part reflects differences in the definitions used and the populations under study. Most studies have suggested that complications are more likely to occur in older adults with comorbid illnesses, particularly those with an infectious process or who have a history of aspiration .
Some of the studies looking at complications found the following:
●In one series, complications were described in 70 percent of 97 patients, of which 88 percent were considered to be minor, including tube dislodgement, peristomal wound leakage, and PEG wound infection .
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- INCIDENCE OF COMPLICATIONS
- COMPLICATIONS THAT MAY OCCUR AT ANY TIME
- Tube dysfunction
- - Wound infection
- - Necrotizing fasciitis
- Peristomal leakage
- Gastric outlet obstruction
- Inadvertent gastrostomy tube removal
- Leakage of gastric contents or tube feeds into the peritoneal cavity
- EARLY COMPLICATIONS OF ENDOSCOPIC GASTROSTOMY TUBE PLACEMENT
- Esophageal and gastric perforation
- Other early complications
- LATE COMPLICATIONS OF GASTROSTOMY TUBE PLACEMENT
- Deterioration of the gastrostomy site
- Buried bumper syndrome
- Colocutaneous fistula
- Persistent gastric fistula following gastrostomy tube removal
- PEG tract tumor seeding
- Other late complications
- COMPLICATIONS RELATED TO TUBE FEEDS
- SUMMARY AND RECOMMENDATIONS