case_images: PMC6333583_01
case_images: Endoscopic bulge identified at percutaneous endoscopic gastrostomy tube site within the stomach.
case_images: pghn-22-86-g001.jpg
case_images: PMC6333583_01_pghn-22-86-g001.jpg
case_images: F1
case_images: 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).
case_images: Guidewire successfully passed through existing percutaneous endoscopic gastrostomy tube from an external approach, allowing subsequent gastrostomy button placement.
case_images: pghn-22-86-g002.jpg
case_images: PMC6333583_01_pghn-22-86-g002.jpg
case_images: F2
case_images: 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).