George Washington University School of Medicine and Health Sciences Washington, DC
Hayley Rogers, MD1, Kerian Dodds, MD2, Matthew Chandler, MD3; 1George Washington University, Washington, DC; 2George Washington University, Alexandria, VA; 3George Washington University School of Medicine and Health Sciences, Washington, DC
Introduction: Early enteral feeding is an essential part of the care of the critically ill patient. Post pyloric feeding in these patients may lower the risk of aspiration pneumonia. Traditional feeding tubes often do not reach the proximal duodenum or do not remain in place if placed correctly. Endoscopic placement is an option but it is invasive, costly, and may ultimately be ineffective due to tube migration back to the stomach. A novel device, the Gabriel Feeding Tube with Balloon, has been designed to address these issues. This device utilizes peristalsis to move its balloon tip to the small intestine. While effective, we are reporting a case of duodenal bulb ulceration as a complication of the Gabriel Feeding Tube balloon.
Methods: A 63 year old female with a history of GERD and Hepatitis C cirrhosis presented for elective lumbar fusion surgery. Her postoperative course was complicated by a dural tear leading to admission to the intensive care unit. In the ICU, she developed pneumonia with altered mental status. Enteral feeding was initiated after placement of a Gabriel feeding tube with balloon. Seven days post placement of the Gabriel Feeding tube, the patient developed maroon-colored stool suggestive of an upper gastrointestinal bleed. An esophagogastroduodenoscopy revealed a large, 11 mm semi-circumferential white based ulcer in the duodenal bulb extending into the postbulbar duodenum. The Gabriel Feeding tube was removed and the patient was treated with a proton pump inhibitor. The patient was negative for H. pylori. No further bleeding occurred. Discussion: Post-pyloric nasogastric tubes have been shown to have lower risk of pneumonia without increase in complications nor decline in nutritional support. The balloon in the Gabriel Feeding Tube ensures proper placement of the tube and assists in movement via peristalsis. However, the balloon may result in unexpected ulceration due to pressure on the intestinal wall as was discovered in this patient. Complications of the Gabriel Feeding Tube have not been reported in the literature. To our knowledge, this is the first reported case of duodenal ulceration as a complication of the Gabriel Feeding Tube with Balloon. More widespread use of this device may result in reporting of this or other complications. Knowledge of potential complications will enhance assessment of risks and benefits and ultimately improve medical decision making in the critically ill patient.
Clean Based Ulcer in the Postbulbar Duodenum
Disclosures: Hayley Rogers indicated no relevant financial relationships. Kerian Dodds indicated no relevant financial relationships. Matthew Chandler indicated no relevant financial relationships.