Patient Discharged From Hospital With Dislodged Feeding Tube

This case involves a male patient who underwent placement of a percutaneous endoscopic gastrostomy (PEG) tube. While the physician was awaiting confirmation that the PEG tube had been placed properly, the patient’s PEG tube became dislodged. The patient was subsequently discharged from the hospital without confirmation that the PEG tube was functional. An expert in gastroenterology was sought to discuss the standard protocols used to confirm the correct placement of the PEG tube.

Question(s) For Expert Witness

1. What has been your experience managing dislodged PEG tubes?

2. What are the standard protocols used to confirm the correct placement of the PEG tube?

Expert Witness Response E-216119

I have significant experience in the diagnosis and managing PEG tube complications. I have received numerous referrals for difficult PEG access, dislodged PEG, buried bumper syndrome, peritonitis, and even necrotizing soft tissue infections from dislodged PEG. I have repaired these using a variety of endoscopic, laparoscopic, and open techniques. I organized a symposium on management of PEG tube complications at the annual meeting of a parenteral nutrition society and have given several talks on the topic. There is no standard protocol for verifying PEG but verification generally consists of careful physical exam, tube injection study, CT scan if there is concern about the site. It is important to note a tube injection study alone can fail to diagnose a dislodged PEG, particularly if there is buried bumper syndrome.