URGENT GASTROSCOPY THROUGH PEG FISTULA APPROACH

Aims:

Gastroscopy in the best way treat upper GI bleeding. In some medical condition natural feeding way is closed. Percutaneous endoscopic gastrostomy (PEG) fistula in such patients is usually narrow for standard gastroscope. Endoscopy of such patient can be challenging. Dieulafoy's lesion is rare cause of GI bleeding.

Methods:

64- year old patient with liver cirrhosis, who had laryngectomy due to carcinoma was admitted in hospital because of hematochezia. In past 6 months he was several times hospitalized because of massive, intermittent, GI bleeding. Gastroscopy throw the natural way couldn't been done because of oesophageal stricture (lumen 3 mm). He had 16Fr PEG and tracheostomy. During earlier examination CT scans didn't show bleeding site. Varices of oesophagus was suspected to bleed. Bleedings was successfully treated with conservative measures.

Results:

We perform gastroscopy with paediatric endoscope throw the PEG fistula. Procedure was unsuccessful because of food filled stomach. Than we do colonoscopy which didn't showed bleeding site in the lower GI. Next day we repeat gastroscopy with retrograde oesophageoscopy up to stricture. There was no variceal or other cause of bleeding. In stomach we confirmed 8 mm angiodysplasia with artery in the center (Dieulafoy's lesion) without active bleeding. We couldn't treat lesion because of no working chanel in paediatric endoscope. Few days later in propofol sedation we surgically wide fistula enough for adult gastroscope. First we treated lesion with 2,5mL of 1% sclerovein, than applied three clips on. At the end we applied 20 Fr PEG tube. Until then, patient had no any GI haemorrhage.

Conclusions:

PEG fistula can also be access port for treatment of upper GI bleeding. Diagnose can be made with paediatric gastroscope. Treatment with adult gastroscope can be done after surgically widening fistula in sedation. Dieulafoy's lesion can be treat with combination therapy.

Keywords:

PEG, Dieulafoy, bleeding.