Percutaneous endoscopic gastrostomy: Indications, technique, complications and management

Table 1 Conditions for which patients are commonly referred for insertion of a percutaneous endoscopic gastrostomy tube

Neurological diseases and psychomotor retardation

Cerebrovascular disease

Motor neuron disease (amyotrophic lateral sclerosis)

Multiple sclerosis

Parkinson’s disease

Cerebral palsy

Dementia

Cerebral tumor

Psychomotor retardation

Reduced level of consciousness

Head injury

Intensive care patients

Prolonged coma

Cancer

Head and neck cancer

Esophageal cancer

Miscellaneous

Burns

Congenital anomaly (e.g., trachea esophageal fistula)

Fistulae

Cystic fibrosis

Short bowel syndromes (such as Crohn’s disease)

Facial surgery

Poly-trauma

Chronic renal failure

HIV/AIDS

Gastric decompression

Abdominal malignancy

HIV/AIDS: Human immunodeficiency virus infection/acquired immunodeficiency syndrome.

Table 2 Contraindications

Serious coagulation disorders (INR > 1.5, PTT > 50 s, platelets < 50000/mm3)

Hemodynamic instability

Sepsis

Severe ascites

Peritonitis

Abdominal wall infection at the selected site of placement

Marked peritoneal carcinomatosis

Interposed organs (e.g., liver, colon)

History of total gastrectomy

Gastric outlet obstruction (if being used for feeding)

Severe gastroparesis (if being used for feeding)

Lack of informed consent for the procedure

Table 3 Complications reported

Minor:

Wound infection

Tube leakage to abdominal cavity (peritonitis)

Stoma leakage

Inadvertent PEG removal

Tube blockage

Pneumoperitoneum

Gastric outlet obstruction

Peritonitis

Major:

Aspiration pneumonia

Hemorrhage

Buried bumper syndrome

Perforation of bowel

Necrotizing fasciitis

Metastatic seeding

PEG: Percutaneous endoscopic gastrostomy.