Mechanism of the development of gastric ulcer after percutaneous endoscopic gastrostomy

Background and Study Aims: The present study was carried out in order to elucidate the mechanism of the development of gastric ulcer, one of the serious complications of PEG tube placement. Patients and Methods: This retrospective study included 92 patients who underwent gastric endoscopy after PEG tube placement. Gastric ulcers detected at gastroscopy were examined in relation to the length of the protrusion from the PEG tubes intra-gastric bumper and the use of histamine H-2-receptor antagonists. Results: Gastric ulcers were found in nine of the 92 patients, and in all nine the ulcer was found on the posterior wall of the gastric body, where the tip of the PEG tube was attached. Seven of the 21 patients (33.3%) who had a PEG tube with a long protrusion from the intragastric bumper developed gastric ulcer. By contrast, only two of the 71 patients (2.8%) who had a PEG tube with a short protrusion developed gastric ulcer. The use of H-2-blockers had no significant impact on the development of gastric ulcer. Conclusions: The occurrence of gastric ulcer after PEG placement was attributable to the shape of the PEG tube within the intragastric space, and not to the use of H-2-blockers, suggesting that appropriate placement of the PEG tube is an important factor in preventing gastric ulcer.