P5016 - The Necessity of Personalized Patient Care: One Size/Type Does Not Fit All

Gomathy A. Nageswaran, MBBS¹, Amy Pham, BS, RD², Deva Christine T. Tojong, MD³, Ronan Calibuso, MD⁴, Viveksandeep Thoguluva Chandrasekar, MD³, John Erikson Yap, MD, MBA, FACG^2
1University of Arkansas for Medical Sciences, Little Rock, AR; ²Metrodora Institute, West Valley City, UT; ³Medical College of Georgia at Augusta University, Augusta, GA; ⁴Jersey City, NJ

Introduction: Percutaneous endoscopic gastrostomy (PEG) tubes offer alternative enteral nutrition routes for patients unable to orally ingest adequate nutrition. There are two primary types of PEG tubes: standard, which provide better drainage, and low-profile, favored for patient comfort. Internal anchoring mechanisms include balloon, capsule domes, and capsule monarchs. In cases of gastric dysfunction, PEG tubes modified with jejunostomy attachments (PEG-J tubes) are used. If inadequate, percutaneous endoscopic jejunostomy (PEJ) tubes are considered. Adaptation of PEG tubes for jejunal placement is common practice, with careful consideration of luminal diameter differences between the stomach and small bowel essential to minimize complications

Case Description/Methods: 34-year-old female with hypermobility syndrome (HS) and mast cell activation syndrome (MCAS) presents with chronic, persistent colicky pain at the PEJ site. The patient relies on PEG and PEJ for nutrition. She reports that feeding exacerbates the pain and describes a sensation of peristalsis in the affected area. Due to the severity of the pain, she is unable to use the PEJ site for administering fluids, medications, and enteral formula, which resulted in significant weight loss.

Initially, a PEG-J tube was placed at the Jejunostomy site, which was exchanged to a low-profile balloon-type PEG tube in the hopes of alleviating pain. Multiple endoscopic procedures with biopsies, along with imaging studies, were performed to determine the etiology of the pain, all of which returned normal results. Notably, endoscopy revealed that the balloon occupied more than two-thirds of the jejunal lumen. The PEJ was replaced with a Monarch-type PEG tube to limit luminal occlusion. This resulted in significant improvement of her colicky pain, enabling her to use the PEJ site for both medications and fluids.

Discussion:
Patients diagnosed with MCAS and HS exhibit heightened visceral hypersensitivity, increased intestinal permeability, and impaired wound healing. Meticulous selection of enteral feeding tubes is crucial to optimize nutrient absorption and reduce complications at the tube site. Traditional criteria for tube selection, such as tube size, patient activity level, and body composition, remain important. However, specific attention to tube placement locations is critical, particularly in jejunal sites. Further research is needed to determine which types of PEG tubes are most suitable for jejunostomy placements in patients with these complex conditions.



Disclosures:


Gomathy A. Nageswaran, MBBS¹, Amy Pham, BS, RD², Deva Christine T. Tojong, MD³, Ronan Calibuso, MD⁴, Viveksandeep Thoguluva Chandrasekar, MD³, John Erikson Yap, MD, MBA, FACG². P5016 - The Necessity of Personalized Patient Care: One Size/Type Does Not Fit All, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.