PMC6333583_01
Endoscopic bulge identified at percutaneous endoscopic gastrostomy tube site within the stomach.
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F1
An esophagogastroduodenoscopy then endoscopically revealed a bulge at the fistula site, which was identified as the internal bumper embedded within the fistula tract but maintained within the gastric lumen (Fig. 1).
Guidewire successfully passed through existing percutaneous endoscopic gastrostomy tube from an external approach, allowing subsequent gastrostomy button placement.
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F2
The external portion of PEG tube was then cut and removed near the level of the skin, allowing passage of an 0.025-inch Jagwire  straight tip, stiff shaft, high performance guidewire (Boston Scientific, Marlborough, MA, USA) through the foreshortened PEG tube in a retrograde fashion into the stomach lumen (Fig. 2).