2015-08-25 20:44:21 UTC

Thinking Outside the Box of the Gastrostomy Kit

Aug. 26, 2015

September's CGH image of the month features a challenging gastronomy tube replacement.

In the September Clinical Gastroenterology and Hepatology image of the month, an 84-year-old man with dementia presented with a six hour history of unintended dislodgement of a percutaneous endoscopic gastrostomy tube placed four months earlier.

Description: Physical examination showed a percutaneous endoscopic gastronomy stoma that was partially closed in the epigastrium, preventing insertion of the balloon gastrostomy tube. After confirming the permeability of the gastrocutaneous tract with a nasogastric tube (Figure A), replacement using a stylet-assisted technique was planned (Figure B). The balloon gastrostomy tube was strengthened by passing a stylet inside, providing increased stiffness while retaining some flexibility, and leaving 2.5 cm of free stylet distal to the balloon gastrostomy tube tip for guidance (Figure C). This stylet is composed of an outer plastic layer and an inner malleable metallic wire that was left 2 cm behind the plastic layer, enhancing its safety (Figure C).

The stylet was introduced into the gastric lumen carefully until a minor resistance was felt, indicating contact of the stylet with the opposite gastric wall. The balloon gastrostomy tube then was smoothly advanced over the stylet (Figure D). After replacement of the balloon gastrostomy tube, the stylet was removed, and the balloon was inflated. Adequate positioning was confirmed by prompt aspiration of gastric fluid contents through the gastrostomy tube.

Find out more about gastronomy tube replacements on CGH

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