Percutaneous Endoscopic Gastrostomy

1
Percutaneous Endoscopic Gastrostomy

• Dr. Bruno Salena
• Division of Gastroenterology
• Hamilton Health Sciences
• McMaster University

2
PEG Tube

• 18F to 28F
• Silicone or polyurethane
• Average longevity of 1 2 years

3
PEG Tube ( low profile)
4
PEG vs. Surgical Gastrostomy

• Lower cost
• Shorter procedure time
• Lower complications

5
PEG - Indications

• For nutrition where patient cannot consume
  sufficient calories to meet metabolic needs
• Impaired swallowing (neurologic, neuro-muscular,
  obstructive neoplasms)
• NG tube associated aspiration
• Gastric decompression

6
PEG - Contraindications

• Inability to bring the anterior gastric wall in
  apposition to the anterior abdominal wall (prior
  subtotal gastrectomy, ascites, marked
  hepatomegaly)
• Severe obesity
• Small bowel fistula
• Infiltrative gastric diseases
• Obstructing esophageal tumour
• Incorrectable coagulopathy

7
PEG - Technique

• Pull method (Gauderer Ponsky, 1980)
• Push method (Russell)
• Radiologic method

8
PEG Technique (Basic elements)

• Gastric insufflation and trans-illumination
• Percutaneous placement of tapered cannula into
  stomach
• Passage of suture or guidewire into stomach
• Placement of gastrostomy tube
• Verification of proper position

9
PEG Technique (Transillumination)
10
PEG Technique (Anesthesia)
11
PEG Technique ( Advance cannula and snare)
12
PEG Technique (guidewire)
13
PEG Technique (confirm position)
14
PEG - Technique
15
PEG - Complications

• Wound infection
• Peritonitis
• Septicemia
• Peristomal leakage
• Tube dislodgement
• Aspiration
• Bowel perforation
• Gastro-colic fistula

16
PEG - Complications

• Pneumo-peritioneum is common
• wound infection risk 5
• Morbidity 3 6
• Mortality 0.3 1

17
PEG Post-operative Care

• Antibiotics x 48 hrs
• Feeds can start in 8 hours
• Water flush of tube
• Daily wash of site with soap and water after
  wound healing
• Wound management (leakage, silver nitrate for
  proud flesh)

18
Percutaneous Endoscopic Jejunostomy

• Severe GERD
• Gastric emptying disorders
• Joint feeding/aspiration

19
PEG Summary Questions

• Safe, efficient and effective
• Acceptable morbidity
• Longer-term feeding
• Ethics