Percutaneous Endoscopic Gastrostomy
Percutaneous endoscopic gastrostomy (PEG) provides a long-term method of enteral feeding for patients with swallowing difficulty.
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Jae Myung Park and Chul-Hyun Lim
Contents 18.1
General Information ..................................................... 410
18.2
Indication ....................................................................... 410
18.3
Contraindication ........................................................... 411
18.4
Prerequisite .................................................................... 411
18.5
Instruments.................................................................... 411
18.6 Technique ....................................................................... 412 18.6.1 The Pull Technique ......................................................... 413 18.6.2 The Introducer Technique ............................................... 417 18.7
Feeding ........................................................................... 421
18.8
Complications ................................................................ 421
Key Summary • Percutaneous endoscopic gastrostomy (PEG) provides a long-term method of enteral feeding for patients with swallowing difficulty. • PEG can be performed with pull (PonskyಣGauderer), push (Sacks-Vine), and introducer (Russel) techniques. • The pull technique is well established and widely used because of its convenience and safety. • The introducer technique has the advantages of low peristomal infection rate and single insertion of endoscope.
References .................................................................................... 423
J.M. Park (*) • C.-H. Lim Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea e-mail: [email protected]; [email protected] © Springer-Verlag Berlin Heidelberg 2015 H.J. Chun et al. (eds.), Therapeutic Gastrointestinal Endoscopy: A Comprehensive Atlas, DOI 10.1007/978-3-642-55071-3_18
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18.1
J.M. Park and C.-H. Lim
General Information
Percutaneous endoscopic gastrostomy (PEG) is a procedure for placing a feeding tube by forming a gastrocutaneous fistula via endoscopy for the purpose of enteral feeding. This technique reduces the length of hospital stay, instrumentation, and cost compared to surgical gastrostomy. With the advancements in tools and techniques required for this procedure, PEG has become the procedure of choice in patients requiring long-term enteral nutrition. PEG can be implanted with several techniques, such as pull (PonskyಣGauderer), push (Sacks-Vine), and introducer (Russel) techniques. The pull technique is well established and widely used because of its convenience and safety. The introducer technique has the advantages of low peristomal infection rate and single insertion of endoscope. In this chapter, we will discuss the indications, instruments, basic principles and various techniques, and lastly complications of PEG.
18.2
Indication
• PEG is indicated in patients who have a functioning gastrointestinal tract but cannot take nutrition by the mouth for at least 4 weeks. • The common causes precluding peroral nutrition are swallowing difficul
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