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A percutaneous endoscopic gastrostomy (PEG) is an endoscopic procedure for placing a tube into the stomach through the abdominal wall. PEG tubes may also be extended into the small bowel.
The procedure is performed in order to place a gastric feeding tube as a long-term means of providing nutrition to patients who cannot take food orally. Many stroke patients, for example, are at risk of aspiration pneumonia due to poor control over the swallowing muscles; some will benefit from a PEG performed to maintain nutrition.
PEGs may also be inserted to decompress the stomach in cases of gastric volvulus.
Techniques
Two major techniques for placing PEGs have been described in the literature.
The Ponsky or Bard-Ponsky pull technique involves performing a gastroscopy to evaluate the anatomy of the stomach. The anterior stomach wall is identified and techniques are used to ensure that there is no organ between the wall and the skin. An angiocath is used to puncture the abdominal wall through a small incision, and a soft guidewire is inserted through this and pulled out of the mouth. The feeding tube is attached to the guidewire and pulled through the mouth out of the incision.
The push technique involves a gastroscopy to evaluate the anatomy. The Seldinger technique is used to place a wire into the stomach, and a series of dilators are used to increase the size of the gastrostomy. The tube is then pushed in over the wire.
Contraindications
As with the case of other types of feeding tubes, care must be made to place PEGs into an appropriate population. The following are contraindications to PEG use:
- peritonitis
- short life span
- abdominal wall infection
- abdominal burns
- high aspiration risk
- atypical abdominal anatomy (e.g. malrotation)
Complications
- Gastrocolic fistula: suspect if diarrhea appears short time after feeding. In this case, the food goes direct from stomach to colon (usually transverse).
- Gastric Separation
- Peritonitis
- Gastrostomy tube site cellulitis
See also
"Percutaneous endoscopic gastrostomy"