Enteral Nutrition Options
- Nasogastric tube: poorly tolerated by patients, difficult to maintain and increased risk of aspiration
- Nasojejunal tube: better than NG tube but easily blocked
- Gastrostomy tube -- can be placed surgically, radiologically or endoscopically
- Jejunostomy tube: alternative to gastrostomy tube in patients with aspiration
Percutaneous Endoscopic Gastrostomy (PEG)
- Placement of gastrostomy tube using the percutaneous approach and guided by concurrent endoscopy.
- "Pull technique" most commonly used today
- Patient is on conscious sedation
- Endoscopy is used to find the optimal puncture site, using "finger pressure"
Indications for PEG
- Need for enteral nutrition in patients unable to swallow
- Provision of supplemental feeding or bile replacement
- Gastric decompression in cases of chronic intestinal obstruction
Complications of PEG
- Overall, 8% - 30%. Serious complications at approximately 1% - 4%
- Pneumoperitoneum is frequently observed after PEG placement and is not regarded as a complication
- Most frequent complication = local wound infection
Our case - left rectus sheath hematoma following PEG placement.
1. Loser C, Aschi G, Hebuterne X, et al. ESPEN guidelines on artificial enteral nutrition - percutaneous endoscopic gastrostomy (PEG). Clin Nutrition 2005;24:848-861.
2. Ponsky JL. Percutaneous endoscopic gastrostomy. J Gastroenterol Surg 2004;901-904.