On the Bleeding Edge: Mastering GI Emergencies and Inpatient GI Consultation (On-Demand) | 2026-Enteral Access & Managing Complications

Video Transcription

Video Summary

Dan Stein’s lecture reviewed endoscopic enteral access, emphasizing that gastroenterologists can manage many patients who need feeding tubes and related complications.<br /><br />For PEG placement, he described the Russell introducer technique as an option when a pull PEG is unsuitable, such as with a tight esophagus or concern about tumor seeding. He highlighted updated ASGE guidance favoring endoscopic placement when anatomy is normal, avoiding routine interruption of antiplatelet therapy, and starting feeds about four hours after placement.<br /><br />For PEG-J tubes, he recommended choosing a suitable one-piece tube, aiming the tract toward the pylorus, and mastering reliable advancement techniques, such as using rat-tooth forceps. Direct PEJ placement can be useful when the stomach is inaccessible or unsuitable, though jejunal stomas may leak more often.<br /><br />The lecture also covered managing leakage, buried bumpers, tube dislodgement, infection, granulation tissue, clogging, aspiration, and gastrocolocutaneous fistulas. Key principles included avoiding tube upsizing for leakage, reducing external tension, securing immature tracts after dislodgement, and elevating patients during and after feeds. For patients with dementia or aspiration concerns, Stein stressed careful goals-of-care discussions and generally favored PEG over PEG-J unless gastric feeding is not tolerated.

Asset Subtitle

Daniel J. Stein, MD, MPH

Keywords

endoscopic enteral access

PEG placement

Russell introducer technique

PEG-J tubes

direct PEJ

feeding tube complications

gastroenterology guidelines

ASGE guidelines

aspiration risk