An 89-year-old woman, who had a medical history of dysphagia due to advanced Alzheimer's disease, was referred to the author's department with melena and anemia (hemoglobin level 5.7 g/dL). Forty-eight days previously, the patient underwent percutaneous endoscopic gastrostomy (PEG) using a bumper-button-type catheter (Ideal Button, Olympus, Tokyo, Japan). Emergency esophagogastroduodenoscopy (EGD) revealed an exposed vessel with active oozing at the site of contact with the internal PEG catheter bumper (Fig. 1A–C). Endoscopic ethanol injection was performed to control hemorrhaging, and a tube-type catheter (Neofeed Gastrostomy Tube, Top, Tokyo, Japan) was replaced with sufficient length for the prevention of contact rebleeding (Fig. 1D). In addition, parenteral nutrition and intravenous administration of a proton pump inhibitor (lansoprazole 30 mg twice-daily) were started. One week later, a follow-up EGD confirmed the disappearance of the exposed vessel (Fig. 2); thus, enteral nutrition was restarted.
FIG. 1. (A–C) Endoscopic view of an exposed vessel with active oozing at the site of contact with the internal gastrostomy catheter bumper. (D) Replacement of a tube-type catheter with sufficient length after endoscopic ethanol injection.
FIG. 2. Endoscopic view of the disappearance of the exposed vessel.
PEG enables long-term enteral nutrition and has been widely used especially for geriatric patients in an increasingly aging society.1 Although PEG is a well-tolerated procedure, several complications include hemorrhage, dislodgement, perforation, and peritonitis. Particularly, hemorrhage from the gastrocutaneous fistula is a common complication of PEG, whereas upper gastrointestinal bleeding caused by pressure from a gastrostomy catheter bumper or balloon is less likely to occur.2 However, active bleeding from an exposed vessel can be fatal. Physicians should take into account removal and placement of the gastrostomy catheter in a different location.3 Furthermore, replacement of a gastrostomy catheter with a low-profile internal bumper can be effective in the treatment of this complication.3
Footnotes
CONFLICT OF INTEREST STATEMENT: None declared.
References
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