TAKE HOME POINTS
1.Percutaneous endoscopic gastrostomy (PEG) is the most commonly used enteral access device.
2.Diarrhea in patients who are receiving tube feeds is most commonly NOT related to the tube feeds
3.Don’t miss infections like C difficile, evaluate medications and other osmotic agents which may cause diarrhea and rule out constipation and overflow as a cause.
4.Buried Bumper syndrome is rare but consider this when the PEG site is extremely tender, there is loss of patency of the tube and leakage around the tube.
REFERENCES
Sripongpun P, Lertpipopmetha K, Chamroonkul N, Kongkamol C. Diarrhea in tube-fed hospitalized patients: Feeding formula is not the most common cause. J Gastroenterol Hepatol. 2021 Sep;36(9):2441-2447. Epub 2021 Mar 20. PMID: 33682192.
Ma MM, Semlacher EA, Fedorak RN, Lalor EA, Duerksen DR, Sherbaniuk RW, Chalpelsky CE, Sadowski DC. The buried gastrostomy bumper syndrome: prevention and endoscopic approaches to removal. Gastrointest Endosc. 1995 May;41(5):505-8. doi: 10.1016/s0016-5107(05)80012-4. PMID: 7615232
Cyrany J, Rejchrt S, Kopacova M, Bures J. Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy. World J Gastroenterol. 2016 Jan 14;22(2):618-27.PMID: 26811611; PMCID: PMC4716063.
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