Skip to main content
SpringerLink
Log in

Persistent Ostomy Following Percutaneous Endoscopic Gastrostomy Removal: Treatment Strategies

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this article is to review available literature on management of persistent ostomy following PEG tube removal. We will discuss the incidence of persistent gastrocutaneous fistula (GCF) following PEG tube removal, risk factors for their development, and management strategies that have been proposed and their efficacy.

Recent Findings

The use of over the scope clips (OTSC) have evolved recently in the management of gastrointestinal bleeding, perforation, and fistula closures. OTSC has become more readily available and proven to be effective and safe. Suturing devices have shown promising results.

Summary

Persistent gastrocutaneous fistula following PEG removal is a rare yet serious complication that can lead to continuous skin irritation and leakage of gastric contents and acid. There are several postulated risk factors but the most important of these is duration of placement. Management can include medical therapy which has recently been shown to be somewhat effective, endoscopic therapy and surgery as a last resort. Overall, the data on GCFs is limited and further study with larger sample size is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. **Schrag SP, Sharma R, Jaik NP, Seamon MJ, Lukaszczyk JJ, Martin ND, Hoey BA, Stawicki SP. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis. 2007;16(4):407–18. PMID: 18193123. Comprehensive article in discussing complications.

  2. **Janik TA, Hendrickson RJ, Janik JS, Landholm AE. Analysis of factors affecting the spontaneous closure of a gastrocutaneous fistula. J Pediatr Surg. 2004;39(8):1197–9. https://doi.org/10.1016/j.jpedsurg.2004.04.007. PMID: 15300526. Excellent in highlighting risk factors for failed closure.

  3. ** Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous endoscopic gastrostomy: indications, technique, Complications and management. World J Gastroenterol. 2014;20(24):7739–51. https://doi.org/10.3748/wjg.v20.i24.7739. PMID: 24976711; PMCID: PMC4069302. Practical Clinical guide.

  4. Currais P, Faias S, Francisco F, Sousa L, Gramacho J, Pereira AD. Gastrocutaneous fistulas after PEG removal in adult cancer patients: frequency and treatment options. Surg Endosc. 2021;35(5):2211–2216. https://doi.org/10.1007/s00464-020-07627-z. Epub 2020 May 11. PMID: 32394169.

  5. Gauderer MW, Stellato TA. Gastrostomies: evolution, techniques, indications, and Complications. Curr Probl Surg. 1986;23(9):657–719. https://doi.org/10.1016/0011-3840(86)90020-1. PMID: 3095034.

    Article  CAS  PubMed  Google Scholar 

  6. Harris LS, Luck JE, Atherton RR. Suboptimal identification of patient-specific risk factors for poor wound healing can be improved by simple interventions. Int Wound J. 2017;14(1):138–41. https://doi.org/10.1111/iwj.12573. Epub 2016 Mar 22. PMID: 27000636; PMCID: PMC7949665.

    Article  PubMed  Google Scholar 

  7. Deen OJ, Parisian KR, Harris C 3rd, Kirby DF. A novel procedure for gastrocutaneous fistula closure. J Clin Gastroenterol. 2013;47(7):608 – 11. https://doi.org/10.1097/MCG.0b013e3182819c7c. PMID: 23426456.

  8. Kobak GE, McClenathan DT, Schurman SJ. Complications of removing percutaneous endoscopic gastrostomy tubes in children. J Pediatr Gastroenterol Nutr. 2000;30(4):404–7. https://doi.org/10.1097/00005176-200004000-00010. PMID: 10776951.

    Article  CAS  PubMed  Google Scholar 

  9. Hameed H, Kalim S, Khan YI. Closure of a nonhealing gastrocutanous fistula using argon plasma coagulation and endoscopic hemoclips. Can J Gastroenterol. 2009;23(3):217–9. https://doi.org/10.1155/2009/973206. PMID: 19319387; PMCID: PMC2694658.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Deruyter L, Van Blerk M, Cadière GB, De Graef J, Willems G. Treatment of high-output gastric fistulas with omeprazole. Hepatogastroenterology. 1991;38(Suppl 1):83–6. PMID: 1823072.

    PubMed  Google Scholar 

  11. Skorjanec S, Dolovski Z, Kocman I, Brcic L, Blagaic Boban A, Batelja L, Coric M, Sever M, Klicek R, Berkopic L, Radic B, Drmic D, Kolenc D, Ilic S, Cesarec V, Tonkic A, Zoricic I, Mise S, Staresinic M, Ivica M, Lovric Bencic M, Anic T, Seiwerth S, Sikiric P. Therapy for unhealed gastrocutaneous fistulas in rats as a model for analogous healing of persistent skin wounds and persistent gastric ulcers: stable gastric pentadecapeptide BPC 157, atropine, ranitidine, and omeprazole. Dig Dis Sci. 2009;54(1):46–56. https://doi.org/10.1007/s10620-008-0332-9. Epub 2008 Jul 23. PMID: 18649140.

  12. Lomis NN, Miller FJ, Loftus TJ, Whiting JH, Giuliano AW, Yoon HC. Refractory abdominal-cutaneous fistulas or leaks: percutaneous management with a collagen plug. J Am Coll Surg. 2000;190(5):588 – 92. https://doi.org/10.1016/s1072-7515(00)00237-4. PMID: 10801026.

  13. González-Ojeda A, Avalos-González J, Muciño-Hernández MI, López-Ortega A, Fuentes-Orozco C, Sánchez-Hochoa M, Anaya-Prado R, Arenas-Márquez H. Fibrin glue as adjuvant treatment for gastrocutaneous fistula after gastrostomy tube removal. Endoscopy. 2004;36(4):337 – 41. https://doi.org/10.1055/s-2004-814412. PMID: 15057685.

  14. Macedo C, Almeida N, Alves AR, Ferreira AM, Figueiredo P. Persistent Peristomal Leakage from Percutaneous Endoscopic Gastrostomy successfully treated with argon plasma coagulation. GE Port J Gastroenterol. 2021;28(3):210–4. https://doi.org/10.1159/000510066. Epub 2020 Oct 7. PMID: 34056046; PMCID: PMC8138229.

    Article  PubMed  Google Scholar 

  15. Lee YC, Na HG, Suh JH, Park I-S, Chung KY, Kim NK. Three cases of fistulae arising from gastrointestinal tract treated with endoscopic injection of Histoacryl. Endoscopy. 2001;33(2):184-6. https://doi.org/10.1055/s-2001-11670. PMID: 11272222.

  16. Duddempudi S, Ghevariya V, Singh M, Krishnaiah M, Anand S. Treatment of persistently leaking post PEG tube gastrocutaneous fistula in elderly patients with combined electrochemical cautery and endoscopic clip placement. South Med J. 2009;102(6):585-8. https://doi.org/10.1097/SMJ.0b013e3181a5a6a2. PMID: 19434012.

  17. Masaki S, Yamada K. Over-the-scope Clip Closure of Persistent Gastrocutaneous Fistula after Percutaneous endoscopic gastrostomy tube removal: a report of two cases. Cureus. 2021;13(2):e13206. https://doi.org/10.7759/cureus.13206. PMID: 33728166; PMCID: PMC7946610.

    Article  PubMed  PubMed Central  Google Scholar 

  18. **Heinrich H, Gubler C, Valli PV. Over-the-scope-clip closure of long lasting gastrocutaneous fistula after percutaneous endoscopic gastrostomy tube removal in immunocompromised patients: a single center case series. World J Gastrointest Endosc. 2017;9(2):85–90. https://doi.org/10.4253/wjge.v9.i2.85. PMID: 28250901; PMCID: PMC5311477. Novel technique.

  19. Tasaki T, Arakaki Y, Murakami K, Fujioka T. Closure of persistent gastrocutaneous postpercutaneous endoscopic gastrostomy fistula by simple percutaneous suturing with endoscopic assist. Gastrointest Endosc. 2012;76(3):699–700. https://doi.org/10.1016/j.gie.2012.03.1404. PMID: 22898426.

  20. Sultan M, Romero R, Evans J, Shah J, El-Chafic A. Persistent gastro-cutaneous fistula closure with tack suture system in the setting of a severe esophageal stricture. VideoGIE. 2022;7(6):205–7. https://doi.org/10.1016/j.vgie.2022.02.010. PMID: 35686220; PMCID: PMC9171912.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The review was conducted with no funding source. We, authors, declare no conflict of interest or competing interests.

Author information

Authors and Affiliations

  1. Virginia Commonwealth University Health Systems, Richmond, VA, USA

    Alsiddig Elmahdi

  2. Allegheny Center for Digestive Health, Allegheny Health Network, Pittsburgh, PA, USA

    Mohamed Eisa

  3. Department of Surgery, Oregon Health Sciences University, Portland, OR, USA

    Robert Martindale

  4. Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, 530 S Jackson St ACB bldg 3rd floor, 40202, Louisville, KY, USA

    Endashaw Omer

Authors
  1. Alsiddig Elmahdi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed Eisa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Martindale
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Endashaw Omer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Endashaw Omer.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: There was a mistake in article title. From Persistent Ostomy Following Percutaneous Endosecopic Gastrostomy Removal: Treatment Strategies to Persistent Ostomy Following Percutaneous Endoscopic Gastrostomy Removal: Treatment Strategies

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elmahdi, A., Eisa, M., Martindale, R. et al. Persistent Ostomy Following Percutaneous Endoscopic Gastrostomy Removal: Treatment Strategies. Curr Gastroenterol Rep 26, 53–56 (2024). https://doi.org/10.1007/s11894-023-00912-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-023-00912-6

Keywords

Search

Navigation