Percutaneous endoscopic gastrostomy (PEG ) tube placement

A method of placing a tube into the stomach percutaneously, aided by endoscopy.

The pull method is the most commonly used.

An estimated 100,000-125,000 are performed annually in the United States.2

The main indications are establishing enteral access for feeding and gut decompression.

Patients who may benefit from the procedure include those with: with neurological disorders such as stroke, cerebral palsy, brain injury, amyotrophic lateral sclerosis, and impaired swallowing.

Patients who have trauma, cancer, or recent surgery of the upper gastrointestinal or the respiratory tract may require this procedure to maintain nutrition.

Gut decompression may be needed in patients who have abdominal malignancies causing gastric outlet or small bowel obstruction or ileus.

Absolute contraindications to the procedure include uncorrected coagulopathy or thrombocytopenia, severe ascites, sepsis, intraabdominal perforation, peritonitis, abdominal wall infection, gastroparesis, gastric outlet obstruction, history of total gastrectomy, and hemodynamcic instability

Relative contraindications include presence of oropharyngeal or esophageal malignancy that could seed malignancy, portal hypertension, hepatosplenomrgaly, abdominal adhesions from prior surgery, ventral hernia, and history of partial gastrectomy.

With advanced dementia feeding tubes do not improve survival or prevent aspiration pneumonia.

Feeding tubes are not associated with prevention or improved healing of pressure ulcers (Teno JM et al).

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