Natural Orifice Translumenal Endoscopic Surgery (NOTES) represents an emerging technology. In this case report, we describe the management of a patient with a prematurely removed PEG utilizing NOTES techniques.

Three days after PEG placement, the g-tube was inadvertently dislodged and contrast study via a replacement catheter showed contrast extravasation.

Under conscious sedation in the ICU, EGD was performed. Via the presumptive previous gastrotomy, a 12 mm dilating balloon easily advanced into the peritoneal cavity. Inflation of the balloon followed by withdrawl permitted advancement of the endoscope into the peritoneal cavity.

The small bowel,colon, spleen, liver, gallbladder, proximal stomach and diaphragm were readily visualized and there was no obvious peritoneal soilage.

For PEG "Rescue", a guidewire was placed into the peritoneal cavity via the previously placed replacment catheter and the PEG was reestablished using a standard pull technique. Follow-up contrast study on POD #4 showed no leak and tube feeds were restarted and patient had no evidence of subsequent complication.

NOTES PEG "Rescue" in the setting of a dislodged PEG tube may spare individual patients the physiologic stress of traditional surgery. PEG "Rescue" represents a unique, practical, and empowering application of the burgeoning experience of NOTES.