A 16 year old severely handicapped boy is referred for a PEG as he has become increasingly difficult to feed without regurgitation and vomiting.
a) abandon the procedure and refer the case back to the original team
b) refer for a radiologically placed percutaneous feeding tube
c) dilate the stricture but not place a PEG
d) reintubate with a superslim endoscope and place a PEG
e) dilate the stricture and place a standard PEG feeding tube
This is a recent "real case" of mine! Endoscopy is unforgiving. You now have 60 seconds to make the correct decision. Any further consideration will come across as "dithering" to the attending anaesthetic and endoscopic team. If you make the wrong decision, the report will become a testimony to your poor judgement which will be placed in the patient records for eternity ...
You have 50 seconds left to decide .
Bjorn Rembacken is at Leeds Teaching Hospitals NHS Trust, Leeds, UK. He was born in Sweden and qualified from Leicester University in 1987. He undertook his postgraduate education in Leicester and in Leeds. His MD was dedicated to inflammatory bowel disease. Dr Rembacken was appointed Consultant Gastroenterologist, Honorary Lecturer at Leeds University and Endoscopy Training Lead in 2005. Follow Bjorn on Twitter @Bjorn_Rembacken
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