SHM Converge Scientific Abstract ePoster Gallery-Pteg, Peg, Pej, and Ng: The Alphabet Soup of Enteric Access

Pdf Summary

This case highlights percutaneous transesophageal tube (PTEG) placement as a practical alternative for enteric access when PEG or PEJ are not feasible.<br /><br />A 79-year-old woman with metastatic gallbladder cancer status post Whipple and chemotherapy, chronic diarrhea, CKD, and type 2 diabetes was admitted for worsening cachexia, poor oral intake, deconditioning, falls, and failure to thrive. On exam she appeared severely malnourished with bitemporal wasting, dry mucous membranes, scaphoid abdomen, and skin tenting. CT abdomen/pelvis showed diffuse small bowel enhancement suggestive of enteritis, ascites, and bilateral pleural effusions. Despite supportive care, she had persistent inadequate intake. An NG tube was placed early in hospitalization, but this prevented discharge to subacute rehabilitation because of dislodgement risk.<br /><br />The team evaluated for PEG or PEJ placement, but these were contraindicated due to refractory ascites related to severe malnutrition and hypoalbuminemia. Because long-term enteral access was still required, PTEG was placed on hospital day 28. This allowed safe nutritional support and enabled discharge to subacute rehabilitation on hospital day 38. Over time, her ascites improved and she later underwent outpatient PEG placement.<br /><br />The case emphasizes that PTEG is a minimally invasive, well-tolerated, and secure enteral access option that may be under-recognized, especially in patients in whom standard gastrostomy or jejunostomy is contraindicated.

Asset Subtitle

Nicholas Bianchina

Meta Tag

Author List Claire Brickson, Diana Mancini, Matthew Rockstrom, Nicholas Bianchina, Sarah Nodine

Category Clinical Vignettes

Concept Percutaneous Transesophageal Tube

Concept PEG Tube Placement

Concept Percutaneous Endoscopic Jejunostomy

Concept Enteral Feeding Access

Concept Refractory Ascites

Distinguished Non-Finalist

Presenter Organization University of Colorado School of Medicine

Presenting Author Nicholas Bianchina

Track Adult

Keywords

percutaneous transesophageal tube

PTEG

enteral access

PEG contraindication

PEJ contraindication

ascites

malnutrition

cachexia

subacute rehabilitation

gallbladder cancer

Percutaneous Transesophageal Tube

PEG Tube Placement

Percutaneous Endoscopic Jejunostomy

Enteral Feeding Access

Refractory Ascites