Fluroscopy to assess gastrostomy tube position
Interventional radiologyCase Type
Lloret del Hoyo, Juan; González Nieto, Claudia Jimena; Leyva Vásquez-Caicedo, Marco; Méndez Montero, José; Armijo Astrain, Javier EduardoPatient
89 years, female
89-year-old female patient diagnosed with oral cavity epidermoid carcinoma. Post-treatment oropharingeal mucositis led to the need of gastrostomy. PEG insertion was performed and the patient tolerated enteral feeding. After PEG replacement the patient complained of diarrhoea, abdominal pain and feeling uncomfortably full after meals.
Fluoroscopy revealed misplacement of the PEG tube tip in the first portion of the duodenum, highlighted by the presence of iodine contrast in the first and second portion of the duodenum (Fig. 1).
Fluoroscopy control after the gastrostomy tube was correctly placed in the gastric fundus (arrows, Fig. 2).
Abdominal AP X-ray was performed in a 3-month follow-up, confirming the correct position of the PEG tube in the gastric fundus (Fig. 3).
Dumping syndrome is a common complication after gastric, duodenal or bariatric surgery, probably caused by alterations in gastric anatomy or interference with its innervation. Dumping syndrome is characterised by a constellation of symptoms that can be categorised as early dumping syndrome (usually characterised by GI symptoms) or late dumping syndrome (usually occurring 1-3 hours after a meal and characterised by hypoglycaemia-related symptoms). 
Our patient presented with suggestive symptoms of early dumping syndrome such as diarrhoea, abdominal pain and bloating.
Some cases of gastrostomy misplacement in the duodenum have been reported in the literature .
In our case as the symptoms had started after the replacement of the gastrostomy tube, misplacement was suspected.
Gastrostomy tube migration to the duodenum is a complication that we usually see in those patients that have a longer intraluminal catheter than those with balloon-type catheter that have a shorter intraluminal tip in the gastric cavity.
In our case the symptoms had started 4 days after the replacement of the gastrostomy tube, misplacement was suspected and it was confirmed with fluoroscopy (Fig. 1). With the help of a guide wire the gastrostomy tube was correctly placed in the gastric fundus (arrows, Fig. 2). In a 3-month follow-up the patient reported no symptoms. Abdominal AP X-ray was performed confirming the correct position of the PEG tube in the gastric fundus (Fig. 3).
Written informed patient consent for publication has been obtained.
 Van Beek AP, Emous M, Laville M, Tack J (2017) Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management. Obesity reviews Jan 18(1):68-85 (PMID: 27749997)
 Shimoda M, Saraya T, Ogawa Y, Tanaka Y. (2015) Dumping Syndrome due to the Misplacement of the Gastrostomy Feeding Tube. Internal Medicine (Tokyo, Japan) 54(19):2529 (PMID: 26424320)