Single-step replacement of a push-type PEG with a pull-type PEG in a patient with dysphagia

Percutaneous endoscopic gastrostomy (PEG) is a widely used procedure for patients requiring long-term enteral nutrition.PEG tubes vary in insertion method (push-type or pull-type) and lumen diameter.Among them, the 15 Fr push-type PEG tube is commonly used for initial placement due to its ease of insertion and relatively less invasive nature.Typically, after initial insertion of a push-type PEG tube, it is replaced with a tube of similar size (e.g., 16 Fr) or gradually upsized to a larger-bore tube over time.In this case, we report an 83-year-old male patient who experienced cognitive decline following a subarachnoid hemorrhage in August 2023.Although his swallowing function remained intact, decreased attention and concentration led to concerns about insufficient oral intake, warranting the initiation of long-term enteral feeding.A 15 Fr push-type PEG tube was inserted on December 29, 2023, and after approximately three months, on April 17, 2024, the tube was successfully replaced in a single step with a 24 Fr pull-type PEG tube.This case demonstrates the clinical feasibility of one-step replacement to a largebore PEG tube, differing from the conventional gradual up-sizing approach, when the tract is sufficiently matured.