Placement of PEG tubes through previously placed self-expanding esophageal metal stents

Palliative use of percutaneous endoscopic gastrostomy and percutaneous endoscopic cecostomy tubes

Percutaneous endoscopic gastrostomy (PEG) tubes are most commonly placed for feeding purposes with the intention of maintenance or improvement in nutritional status; however, they may also be used in a palliative role in patients who have terminal illnesses for feeding or decompression. Percutaneous endoscopic cecostomy (PEC) tubes can be used to decompress malignant and functional bowel disorders with accepted morbidity and mortality. This article reviews the use of PEG and PEC tubes for palliative use.

Minimizing endoscopic complications: endoluminal stents

Almost all endoluminal stents used by gastroenterologists in the United States are self-expandable metal stents, and they are placed most commonly for relief of malignant luminal obstruction. Recently, a plastic self-expandable stent was approved for treating refractory benign esophageal strictures. Endoluminal stent placement is associated with myriad of complications. Some of these complications can be avoided or minimized by the endoscopist, whereas others are beyond the endoscopist's control. This article covers the various complications that can occur following self-expandable stent placement and provides recommendations on how to minimize these complications.

Acute complications associated with bedside placement of feeding tubes

Several types of feeding tubes can be placed at a patient's bedside; examples include nasogastric, nasointestinal, gastrostomy, and jejunostomy tubes. Nasoenteral tubes can be placed blindly at bedside or with the assistance of placement devices. Nasoenteric tubes can also be placed via fluoroscopy and endoscopy. Gastrostomy and jejunostomy tubes can be placed using endoscopic techniques. This paper will describe the indications and contraindications for different types of tubes that can be placed at the bedside and complications associated with tube placement. Complications associated with nasoenteral tubes include inadvertent malpositioning of the tube, epistaxis, sinusitis, inadvertent tube removal, tube clogging, tube-feeding-associated diarrhea, and aspiration pneumonia. Complications from percutaneous gastrostomy and jejunostomy tube placements include procedure-related mishaps, site infection, leakage, buried bumper syndrome, tube malfunction, and inadvertent removal. These complications will be reviewed, along with a discussion of incidence, cause, treatment, and prevention approaches.

Complications of stent placement for benign stricture of gastrointestinal tract

AIM: To observe the frequent complications of stent placement for stricture of the gastrointestinal tract and to find proper treatment.

METHODS: A total number of 140 stents were inserted in 138 patients with benign stricture of the gastrointestinal tract. The procedure was completed under fluoroscopy in all of the patients.

RESULTS: Stents were successfully placed in all the 138 patients. Pains occurred in 23 patients (16.7%), slight or dull pains were found in 21 patients and severe chest pain in 2 respectively. For the former type of pain, the patients received only analgesia or even no treatment, while peridural anesthesics was conducted for the latter condition. Reflux occurred in 16 of these patients (11.6%) after stent placement. It was managed by common antireflux procedures. Gastrointestinal bleeding occurred in 13 patients (9.4%), and was treated by hemostat. Restenosis of the gastrointestinal tract occurred in 8 patients (5.8%), and was apparently associated with hyperplasia of granulation tissue. In 2 patients, the second stent was placed under X-ray guidance. The granulation tissue was removed by cauterization through hot-node therapy under gastroscope guidance in 3 patients, and surgical reconstruction was performed in another 3 patients. Stent migration occurred in 5 patients (3.6%), and were extracted with the aid of a gastroscope. Food-bolus obstruction was encountered in 2 patients (1.4%) and was treated by endoscope removal. No perforation occurred in all patients.

CONCLUSION: Frequent complications after stent placement for benign stricture of the gastrointestinal tract include pain, reflux, bleeding, restenosis, stent migration and food-bolus obstruction. They can be treated by drugs, the second stent placement or gastroscopic procedures depend on the specific condition.