<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452021000300210</article-id>
<article-id pub-id-type="doi">10.1159/000510066</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Persistent Peristomal Leakage from Percutaneous Endoscopic Gastrostomy Successfully Treated with Argon Plasma Coagulation]]></article-title>
<article-title xml:lang="pt"><![CDATA[Extravasamento persistente peri-estoma de gastrostomia endoscópica percutânea tratado com sucesso com coagulação árgon-plasma]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Macedo]]></surname>
<given-names><![CDATA[Cláudia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Almeida]]></surname>
<given-names><![CDATA[Nuno]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alves]]></surname>
<given-names><![CDATA[Ana Rita]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ferreira]]></surname>
<given-names><![CDATA[Ana Margarida]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Figueiredo]]></surname>
<given-names><![CDATA[Pedro]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalar e Universitário de Coimbra Gastroenterology Department ]]></institution>
<addr-line><![CDATA[Coimbra ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,University of Coimbra Faculty of Medicine ]]></institution>
<addr-line><![CDATA[Coimbra ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital Distrital da Figueira da Foz Gastroenterology Department ]]></institution>
<addr-line><![CDATA[Coimbra ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>06</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>06</month>
<year>2021</year>
</pub-date>
<volume>28</volume>
<numero>3</numero>
<fpage>210</fpage>
<lpage>214</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452021000300210&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452021000300210&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452021000300210&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Percutaneous endoscopic gastrostomy is a safe and effective technique and its use is widely spread. Peristomal leakage may occur within the first few days after gastrostomy tube placement and also in the mature gastrostomy tract. The initial treatment involves conservative measures. If the leakage does not resolve, different endoscopic interventions could be necessary with consequent impairing of enteral nutrition and, in some cases, the need of creating a new gastro-cutaneous fistula.  Case Report: We present 4 consecutive cases complicated with late peristomal leakage and medical treatment failure. These patients underwent upper digestive endoscopy, and circumferential fulguration of the mucosa surrounding the tube with pulsed argon plasma coagulation (APC) at 50 W and 1 L/min flow rate was performed. Additional long through-the-scope clips were applied in 2 cases, since the inner orifice remained enlarged, in order to obtain a better closure. Complete leakage and skin changes resolution occurred between 2 and 6 weeks after the procedure (mean 3.5 weeks). The overall mean follow-up was 19 months after the endoscopic procedure (maximum 30 months, minimum 10 months). There was no recurrence of leakage.  Conclusion: The use of APC alone or combined with long through-the-scope clips in large internal stoma orifice resolved persistent leakage from percutaneous endoscopic gastrostomy in all 4 presented cases without complications. In our case series, this technique appeared to be an effective, safe, and relatively low-cost alternative to the treatment of persistent peristomal leakage of the mature gastrostomy tract.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução:  A gastrostomia percutânea endoscópica é uma técnica amplamente usada sendo eficaz e segura. O extravasamento persistente é uma complicação possível do procedimento podendo ocorrer precocemente ou apresentar-se de forma tardia. O tratamento inicial passa por medidas conservadoras. Se o extravasamento persistir apesar das mesmas, várias intervenções endoscópicas podem ser necessárias com interrupção subsequente da nutrição entérica e nalguns casos pode ser mesmo necessário a criação de uma nova fístula gastro cutânea.  Apresentação dos casos: Relato de quatro casos consecutivos complicados com extravasamento persistente tardio e com falência ao tratamento conservador. A todos os doentes foi realizada uma endoscopia digestiva alta com fulguração circunferencial com coagulação árgon-plasma (APC) a 50 Watts e fluxo 1L/min. Adicionalmente, em dois casos por presença de orifício interno de grandes dimensões foram aplicados clips longos de modo a obter melhor aproximação dos bordos. Foi conseguida resolução completa do extravasamento e consequentemente das alterações cutâneas em 2 a 6 semanas (média 3,5 semanas). O seguimento após o procedimento foi de 19 meses (máximo 30 meses, mínimo 10 meses). Não se verificaram recorrências do extravasamento.  Conclusão: O uso de APC isoladamente ou em combinação com clips longos nos casos de orifício interno de grandes dimensões resolveu o extravasamento persistente após PEG nos quatro doentes sem registo de complicações. Na nossa série, esta técnica parece ser uma alternativa efetiva, segura e de relativo baixo custo para o tratamento do extravasamento persistente tardio.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Percutaneous endoscopic gastrostomy]]></kwd>
<kwd lng="en"><![CDATA[Peristomal leakage]]></kwd>
<kwd lng="en"><![CDATA[Argon plasma coagulation]]></kwd>
<kwd lng="pt"><![CDATA[Gastrostomia endoscópica percutânea]]></kwd>
<kwd lng="pt"><![CDATA[Extravasamento peri-estoma]]></kwd>
<kwd lng="pt"><![CDATA[Coagulação árgon-plasma]]></kwd>
</kwd-group>
</article-meta>
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