Beyond the PEG: A Masterclass in Enteral Access | September 2025-Recorded Webinar

Video Transcription

Video Summary

The ASGE’s Thursday Night Lights Beyond the PEG masterclass featured expert discussions on advanced enteral access techniques and management of PEG (percutaneous endoscopic gastrostomy) tube complications. Dr. Daniel Stein detailed alternatives to the traditional Ponsky-Pull PEG technique for patients where it’s not feasible, including the suture-based Russell Introducer method applicable even with ultra-slim scopes and ascitic patients. He addressed approaches to PEG-J tubes, advocating for familiarity with various insertion techniques (wire-guided, direct, clip-assisted) and tube types, emphasizing that peg-J tube placement and exchange become more efficient with practice and careful technique. He also presented percutaneous jejunostomy methods, especially for altered anatomy cases, and nasojejunal tube placement options.<br /><br />Dr. Kunjali Padia focused on common PEG complications such as bleeding, buried bumper syndrome, peristomal leakage, gastrocutaneous fistulas, and accidental dislodgement. She reviewed prevention strategies like careful bumper positioning (aiming for ~1cm gap to prevent buried bumpers), acid suppression, tube rotation, and education for tube care and behavioral risk factors. Management techniques ranged from hemostatic gauze and topical agents for bleeding, to innovative closure methods for buried bumpers and fistulas including wire-guided over-the-scope clips, endoscopic suturing, percutaneous suturing, and tract de-epithelialization. She cautioned against blind early tube replacement post-dislodgement to prevent peritonitis and recommended CT imaging before intervention.<br /><br />Their combined insights highlight that with creative approaches, training, and collaboration, GI specialists can provide minimally invasive, effective enteral access beyond standard PEGs and manage complications more confidently, enhancing patient outcomes. Preventative care, procedural skill development, and multidisciplinary teamwork remain key to success.

Keywords

ASGE Thursday Night Lights

Beyond the PEG masterclass

advanced enteral access

PEG tube complications

Russell Introducer method

PEG-J tube insertion techniques

percutaneous jejunostomy

nasojejunal tube placement

PEG complication management

buried bumper syndrome prevention

multidisciplinary GI care