First Year Fellows Endoscopy Course (July 29 - 30)

9-Feeding tubes

Pdf Summary

This document provides an overview of percutaneous gastrostomy tubes (PEG) and the procedure for their placement. PEG tubes are used in patients who are unable to tolerate adequate oral intake for an extended period of time, or for gastric decompression in cases of malignancy, bowel obstruction, or motility disorder.<br /><br />Before the PEG placement, a thorough assessment should be conducted, including evaluating the patient's medications, gastrointestinal anatomy, nutritional status, and co-morbidities. Antibiotic prophylaxis is recommended prior to the procedure, with specific guidelines provided for patients on antithrombotic agents.<br /><br />Contraindications and relative contraindications to PEG placement are discussed, including medical futility and technical issues. The PEG tray contents, PEG technique, proper location of the PEG tube, and securing the bumper are described in detail.<br /><br />Potential adverse events related to PEG placement are outlined, including aspiration, infection, bleeding, pneumoperitoneum, and inadvertent removal. Treatment and prevention strategies for these complications are provided.<br /><br />Issues that may arise after PEG placement, such as leakage, buried bumper syndrome, gastrocolic fistula, and tube migration, are discussed, along with their respective management strategies.<br /><br />Finally, the document concludes with a list of questions for clinicians to consider when evaluating a patient with a PEG tube, including examination of the PEG site, assessment of the type of PEG tube and its position, and evaluation of the external bumper.

Keywords

percutaneous gastrostomy tubes

PEG placement

oral intake

gastric decompression

bowel obstruction

motility disorder

assessment

antibiotic prophylaxis

contraindications

adverse events