How does ulceration of the gastric mucosa occur with PEG placement, and what is its prevalence?

• A. Excessive tension between external and internal bolster; 0.3-2.5%
• B. Bacterial infection of the mucosa; 30%
• C. Tube dislodgement causing ulcer; 5%
• D. Allergic reaction to tube material; 1%

Answer: (A)

Ulceration happens when the external bolster is tightened too much, creating excessive tension along the PEG tract. This pulls on the internal bumper and compresses the gastric mucosa at the gastrostomy site, causing ischemia and erosion into an ulcer. The prevalence is low, typically about 0.3% to 2.5%. Other mechanisms like infection, tube dislodgement, or allergic reaction aren’t the primary causes of PEG-related gastric mucosal ulcers, and their frequencies differ from this mechanism.