Endoscopic repair of gastrostomy after inadvertent removal of percutaneous endoscopic gastrostomy tube.

Percutaneous endoscopic gastrostomy (PEG) tube placement has become the preferred method of enteral feeding for many patients. Neurologic disease and cancer are the most frequent indications for PEG tube placement. PEG tubes are also becoming more frequent in trauma patients for early initiation of enteral feeding. Inadvertent PEG tube removal is a well-known complication of PEG tubes. Patients undergoing PEG tube placement are frequently malnourished and in poor general medical condition, making them relatively high risk for surgical intervention. In the past, after early inadvertent PEG removal, patients underwent laparotomy for surgical repair of the gastrostomy site. Recently, laparoscopic replacement of the PEG tube has been described. We present a new technique of endoscopic repair of the gastrostomy site with hemoclip placement followed by later PEG tube placement.

Current therapy for nonvariceal upper gastrointestinal bleeding.

Upper gastrointestinal bleeding continues to plague physicians despite the discovery of Helicobacter pylori and advances in medical therapy for peptic ulcer disease. Medical therapy with new nonsteroidal anti-inflammatory medications and somatostatin/octreotide and intravenous proton pump inhibitors provides hope for reducing the incidence of and treating bleeding peptic ulcer disease. Endoscopic therapy remains the mainstay for diagnosis and treatment of upper gastrointestinal bleeding. Many methods of endoscopic hemostasis have proven useful in upper gastrointestinal hemorrhage. Currently, combination therapy with epinephrine injection and bicap or heater probe therapy is most commonly employed in the United States. Angiography and embolization play a role primarily when endoscopic therapy is unsuccessful.