Utility of Over-the-Scope Clipping for Closure of a Persistent Post-Percutaneous Endoscopic Gastrostomy Fistula under Long-Term Steroid Therapy

A 50-year-old woman had a percutaneous endoscopic gastrostomy (PEG) tube placed after surgery for pharyngeal cancer. After 21 months, the PEG tube was removed due to improvement of per-oral ingestion. She had taken prednisolone for 31 years for systemic lupus erythematosus. The post-PEG fistula did not close spontaneously. The cause of the fistula was slow wound healing and gastrostomy site inflammation due to long-term steroid therapy. We were able to close the fistula with an over-the-scope clipping (OTSC) system. This case suggests that OTSC is useful for closing persistent post-PEG fistulas in patients receiving long-term prednisolone therapy.

Comparison of Esophageal Acidity between Nasogastric Tube Feeding and Percutaneous Endoscopic Gastrostomy Tube Feeding in Brain Injured Patients

OBJECTIVE: The aim of this study is to evaluate the change of esophageal acidity when feeding via nasogastric tube is replaced by via percutaneous endoscopic gastrostomy (PEG) tube. METHOD: Fourteen patients with brain injury participated in the study. 24-hour pH monitoring was performed during nasogastric tubal feeding. After PEG tube insertion, 24-hour pH monitoring was followed up. There was no difference in medication affecting to esophageal acidity in same patient at both pH monitorings. The results of pH monitorings analyzed with Wilcoxon signed rank test. RESULTS: The total time below pH 4.00 was 135.43+/-190.69 minutes for the patients with nasogastric tube and 25+/-42.74 minutes for PEG tube (p=0.013). The numbers of acid reflux was 42.07+/-47.03 and 21.93+/-22.77 respectively (p=0.074). Of the 14 patients, 9 had acid reflux in nasogastric tubal feeding, which was improved in all 9 patients after PEG. Of the 14 patients, 5 had no acid reflux in nasogastric tubal feeding but 3 of the 5 developed new acid reflux in PEG tubal feeding. CONCLUSION: Percutaneous endoscopic gastrostmy tube feeding was better for acid reflex control. But careful observation is needed after PEG because PEG can develop new acid reflux.