What are the potential complications in percutaneous endoscopic gastrostomy (PEG) tube placement?

Updated: Dec 13, 2018
  • Author: Gaurav Arora, MD, MS; Chief Editor: Danny A Sherwinter, MD  more...
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Potential complications include the following:

  • Cardiopulmonary compromise associated with oversedation
  • Allergic reaction to the sedatives or antibiotic administered
  • Aspiration
  • Infection of the stomal site
  • Peristomal leakage
  • Bleeding
  • Pneumoperitoneum (common; self-limiting)
  • Transient gastroparesis or, rarely, ileus
  • Inadvertent perforation of the colon or small intestine
  • Gastric outlet obstruction caused by internal bumper migrating distally
  • Gastric wall ulceration (with long-standing PEG tubes)
  • Inadvertent PEG tube removal (by an agitated or confused patient)
  • Buried bumper syndrome
  • Colocutaneous fistula (becomes apparent at time of PEG tube replacement)
  • PEG tract tumor seeding
  • Peritonitis (if large ascites present)

Pih et al conducted a single-center study aimed at determining risk factors associated with complications and 30-day mortality after pull-type (n = 139) and introducer-type (n = 262) PEG. [13]  Early mortality was significantly higher in patients with platelet counts lower than 100,000/μL or C-reactive protein (CRP) levels of 5 mg/dL or higher, and it was lower in patients with neurologic disease (eg, dementia, Parkinson disase, neuromuscular disease, or hypoxic brain damage).

A study comparing the outcomes of pull PEG (n = 264) with those of push PEG (n = 59) in acute care settings found that overall complication rates for the two approaches were comparable (20% and 22%, respectively), as were tube dislodgment rates (12% and 9%, respectively); however, the incidence of tube dislodgment associated with major complications was greater for pull PEG (6% vs 2%), though not to a statistically significant degree. [14]

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