Percutaneous endoscopic gastrostomy
 | This article needs additional citations for verification. (September 2010) |
| Percutaneous endoscopic gastrostomy | |
|---|---|
| ICD-9-CM | 43.11 |
Percutaneous endoscopic gastrostomy is an endoscopic
medical procedure in which a tube (PEG tube) is passed into a patient's stomach through the abdominal wall, most commonly to
provide a means of feeding when oral intake is not adequate. The procedure is an alternative to surgical gastrostomy insertion, and does not require a general anesthetic; [[Procedural sedation and
analgesia|mild sedation]] is typically used. PEG tubes may also be
extended into the small intestine by passing a jejunal extension tube (PEG-J tube) through the PEG tube and into the jejunum via the pylorus.[1]
PEG
administration of enteral feeds is the most commonly used method of
nutritional support for patients in the community. 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.[2]
Indications
Gastrostomy may be indicated in numerous situations, usually those in which normal or nutrition (or nasogastric) feeding is impossible. The causes for these situations may be neurological (e.g.
stroke), anatomical (e.g. cleft lip and palate during the
process of correction) or other (e.g. radiation therapy for tumors in head & neck region).
In certain situations where normal or nasogastric feeding is not possible, gastrostomy may be of no clinical benefit. In advanced dementia, studies show that PEG placement does not in fact prolong life.[3] Quality improvement protocols have been developed with the aim of reducing the number of non-beneficial gastrostomies in patients with dementia.[4]
A gastrostomy can be placed to decompress the stomach contents in a patient with a malignant bowel obstruction. This is referred to as a "venting PEG" and is placed to prevent and manage nausea and vomiting.
A gastrostomy can also be used to treat volvulus of the stomach, where the stomach twists along one of its axes. The tube (or multiple tubes) is used for gastropexy, or adhering the stomach to the abdominal wall, preventing twisting of the stomach.[2]
A PEG tube can be used in providing gastric or post-surgical drainage.[5]
Techniques
Two major techniques for placing PEGs have been described in the literature.
The Gauderer-Ponsky 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
(anatomy)|organ]] between the wall and the skin:
- digital pressure is applied to the abdominal wall, which can be seen
indenting the anterior gastric wall by the endoscopist.
- transillumination (diaphanoscopy): the light emitted from the
endoscope within the stomach can be seen through the abdominal wall.
- a small (21G, 40mm) needle is passed into the stomach before the
larger cannula is passed. 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, esophagus, stomach, and out of the incision.[2]
In the
- ^ "Discussion". BCM Gastroenterology Grand Rounds. Baylor College of Medicine.
{{cite web}}: line feed character in|work=at position 5 (help) - ^ a b c Gauderer MW (2001). "Percutaneous endoscopic gastrostomy-20 years later: a historical
perspective". J. Pediatr. Surg. 36 (1): 217–9. doi:10.1053/jpsu.2001.20058. PMID 11150469.
{{cite journal}}: line feed character in|title=at position 66 (help) - ^ Murphy LM, Lipman TO (2003). "Percutaneous endoscopic gastrostomy does not prolong survival in
patients with dementia". Arch. Intern. Med. 163 (11): 1351–3. doi:10.1001/archinte.163.11.1351. PMID 12796072.
{{cite journal}}: line feed character in|title=at position 66 (help) - ^ {{cite journal |author=Monteleoni C, Clark E |title=Using rapid-cycle quality improvement methodology to reduce feeding tubes in patients with advanced dementia: before and after study |journal=BMJ |volume=329 |issue=7464 |pages=491–4 |year=2004 |pmid=15331474 |doi=10.1136/bmj.329.7464.491 |pmc=515202}}
- ^ Gail Waldby, "PEG-J Gastrostomy drainage jejunal feeding tubes" http://surgnurseslinks.com/caluso.htm