PEG “Rescue”: a practical NOTES technique


Dislodged percutaneous endoscopic gastrostomy (PEG) tubes occur commonly and may require urgent surgical intervention in a susceptible patient population. Natural orifice translumenal endoscopic surgery (NOTES) may facilitate PEG rescue and avoid the morbidity associated with contemporary surgical techniques. We report a case of a dislodged PEG tube in the early post-operative period with evidence of incomplete gastrocutaneous tract formation and intra-abdominal leakage. Bedside transgastric NOTES exploration facilitated peritoneoscopy, evacuation of intra-abdominal fluid, and re-establishment of the PEG tube through the original gastrotomy tract. Tube feeds were resumed and postoperative contrast fluoroscopy demonstrated no intra-abdominal leakage from the replaced PEG tube. No postoperative complications related to the NOTES procedure were noted at 30 days of follow-up. PEG rescue represents a unique, practical, and empowering application of the burgeoning experience of NOTES.

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The authors would like to acknowledge the remainder of the case advanced surgical endoscopy team (CASE-T): Amitabh Chak MD, Raymond Onders MD, Michael Rosen MD, Ashley Faulx MD, Judy Jin MD, Christina Williams MD, Steve Schomisch, and Jamie Andrews for continued clinical and laboratory support. Photography and videography services were graciously provided by Gary Coffey.

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Correspondence to Jeffrey M. Marks.

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Marks, J.M., Ponsky, J.L., Pearl, J.P. et al. PEG “Rescue”: a practical NOTES technique . Surg Endosc 21, 816–819 (2007).

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  • Endoscopy
  • PEG
  • Minimally Invasive Surgery