Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Esophageal Perforation after Change of a Percutaneous Endoscopic Gastrostomy Tube

경피적 내시경 위조루관 교환 후 발생한 식도 천공

  • Heo, Seong-Wook (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Kwon, Joong-Goo (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Park, Kyoung-Chan (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Ryu, Jung-Il (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Ju, Dong-Uk (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Ha, Kyung-Ho (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Jung, Jin-Tae (Department of Internal Medicine, Catholic University of Daegu College of Medicine) ;
  • Kim, Ho-Gak (Department of Internal Medicine, Catholic University of Daegu College of Medicine)
  • 허성욱 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 권중구 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 박경찬 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 류정일 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 주동욱 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 하경호 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 정진태 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 김호각 (대구가톨릭대학교 의과대학 내과학교실)
  • Published : 2011.07.30
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Abstract

Percutaneous endoscopic gastrostomy (PEG) has become a widely used and safe method for long-term enteral feeding in patients who are unable to tolerate oral feeding. Although a number of complications can occur following PEG placement, most of these complications are not life threatening. Serious complications occur rarely after this procedure and they include peritonitis, visceral perforation, major gastrointestinal bleeding, and necrotizing fasciitis. An esophageal perforation following PEG placement is very rare and predisposing factors include Zenker's or epiphrenic esophageal diverticuli, esophageal strictures, and mass lesions. We recently experienced a case of distal esophageal perforation following a PEG tube change. The predisposing esophageal perforation factor in this case was uncertain, and we successfully treated the patient with surgical intervention.

경피적 내시경 위조루술은 경구영양을 할 수 없는 환자에게 장기간 경장영양을 할 수 있는 안전한 방법으로 널리 사용되고 있다. 경피적 내시경 위조루술 후에 여러가지 합병증이 생길 수 있지만 이들 중 대부분은 생명에 영향을 미치지 않는다. 심한 합병증에는 복막염, 위장관 천공, 출혈, 괴사성 근막염 등이 있으나 드물게 발생한다. 경피적 내시경 위조루술 후 식도천공은 매우 드물며 위험 인자로 Zenker씨 게실, 식도 협착, 종양 등이 있다. 본 증례에서는 식도 천공의 위험 인자가 뚜렷하지 않음에도 불구하고 경피적 내시경 위조루관 교체 후 식도 천공이 발생하였고 수술적 방법으로 이를 성공적으로 치료하였다.

Keywords

References

  1. Payne KM, King TM, Eisenach JB. The technique of percutaneous endoscopic gastrostomy. A safe and cost-effective alternative to operative gastrostomy. J Crit Illn 1991;6:611-619.
  2. Taylor CA, Larson DE, Ballard DJ, et al. Predictors of outcome after percutaneous endoscopic gastrostomy: a communitybased study. Mayo Clin Proc 1992;67:1042-1049. https://doi.org/10.1016/S0025-6196(12)61118-5
  3. Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980;15:872-875. https://doi.org/10.1016/S0022-3468(80)80296-X
  4. Bruckstein AH. Managing the percutaneous endoscopic gastrostomy tube. Postgrad Med 1987;82:143-146.
  5. Larson DE, Burton DD, Schroeder KW, DiMagno EP. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 1987;93:48-52.
  6. Raha SK, Woodhouse K. The use of percutaneous endoscopic gastrostomy (PEG) in 161 consecutive elderly patients. Age Ageing 1994;23:162-163. https://doi.org/10.1093/ageing/23.2.162
  7. Kim BY, Kim YK, Dong SH, et al. Long term efficacy of percutaneous endoscopic gastrostomy. Korean J Gastrointest En dosc 1992;12:29-35.
  8. Kim SJ, Shin WC, Lee JH. The proper patient selection for percutaneous endoscopic gastrostomy according to the complications and tube replacement. Korean J Gastrointest Endosc 2005;30:60-65.
  9. Finocchiaro C, Galletti R, Rovera G, at al. Percutaneous endoscopic gastrostomy: a long-term follow-up. Nutrition 1997;13:520-523. https://doi.org/10.1016/S0899-9007(97)00030-0
  10. Schrag SP, Sharma R, Jaik NP, et al. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis 2007;16:407-418.
  11. Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. J Gastroenterol Hepatol 2000;15:21-25. https://doi.org/10.1046/j.1440-1746.2000.02004.x
  12. Roberts CGP, Hummers LK, Ravich WJ, Wigley FM, Hutchins GM. A case-control study of the pathology of oesophageal disease in systemic sclerosis (scleroderma). Gut 2006;55:1697-1703. https://doi.org/10.1136/gut.2005.086074
  13. Beasley SW, Catto-Smith AG, Davidson PM. How to avoid complications during percutaneous endoscopic gastrostomy. J Pediatr Surg 1995;30:671-673. https://doi.org/10.1016/0022-3468(95)90687-8