First Year Fellows Endoscopy Course (July 31 - August 1)

9-Feeding tubes

Pdf Summary

This document summarizes key points related to the placement, management, and potential complications of percutaneous gastrostomy tubes (PEGs). PEGs are used when a patient is unable to tolerate adequate oral intake and may be required for nutrition, hydration, medications, or gastric decompression in conditions such as malignancy, bowel obstruction, or motility disorders. Before PEG placement, a careful assessment should be performed, including evaluation of medications, gastrointestinal anatomy, nutritional status, co-morbidities, and obtaining informed consent. Guidelines for managing anti-thrombotic agents during PEG placement are provided, including when to hold and re-start these medications.<br /><br />The PEG technique involves inserting a PEG tube into the stomach at a specific location, using a safe tract technique with simultaneous endoscopic visualization. After the PEG is placed, the bumper is secured and repeat endoscopy is generally not necessary. PEGs can be used immediately for medication administration and feeds can typically begin within four hours of placement. Adverse events that may occur during or after the procedure include aspiration, infection, bleeding, pneumoperitoneum, inadvertent removal, leakage, gastrocolic fistula, buried bumper syndrome, and PEG site metastases.<br /><br />Treatment approaches for these complications are outlined, including stabilizing the tube, wound care, and potential surgical consultation if necessary. Strategies to prevent complications such as early PEG removal or tube migration are also discussed. The document concludes with a checklist of questions to consider when evaluating a patient with a PEG-related concern.

Keywords

Percutaneous gastrostomy tubes

PEGs

oral intake

nutrition

hydration

medications

gastric decompression

bowel obstruction

motility disorders

PEG placement