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September 9, 1992

Removal of Gastrostomy Tubes

Author Affiliations

University of Oklahoma College of Medicine Tulsa

JAMA. 1992;268(10):1270. doi:10.1001/jama.1992.03490100064028

To the Editor.  —Korula and Harma1 and a letter by Vermula2 suggested that cutting a percutaneous endoscopic gastrostomy (PEG) tube at the skin level and allowing passage of the remnant internally is a cost-effective method of gastrostomy removal without serious complications. This method proved to be fatal in a patient who recently came under our care.The patient was an elderly woman who suffered an anoxic brain injury in the immediate postoperative period following a total abdominal hysterectomy. She had a PEG tube placed for feeding purposes. Over the subsequent several months, she was able to resume oral feedings so the gastrostomy tube was removed by the "cost-effective" method.Four weeks after removal of the gastrostomy tube, the patient presented to our emergency department with a 2-day history of increasing abdominal pain and a change in mental status. On presentation, she was noncommunicative and incoherent and had signs