The inner bumper of the PEG tube is dislocated to the cardia and causes complete obstruction.
After careful traction applied from outside, the inner bumper is relocated.
Now many areas of pressure necrosis can be seen (rihgt picture). Gastroscopy was performed for
reflux to the oropharynx. To avoid such dislocations, documentation of the correct position
of the outer bumper (measured on a scale at the outside of the tube) is advisable. The correct position is determined
endoscopically. The inner bumper has to be held firmly to the gastric mucosa by traction induced by
the outer bumper. Twisting of the tube (and the inner bumper) must stiil be possible. It is advisable to note
the correct position (in centimeters).