Abstract
Endoscopic approaches for enteral feeding access are often the preferred methods for long-term nutritional support. Compared to parenteral nutrition, enteral feeding provides physiological and structural benefits to the gastrointestinal tract, which in turn have systemic benefits. Additionally, endoscopic modalities are less invasive than surgical approaches, thereby reducing complication rates and duration of hospital stay. Percutaneous endoscopic gastrostomy (PEG) was first introduced in 1980 and served as a cornerstone for the development of percutaneous endoscopic gastrojejunostomy (PEG-J), and percutaneous endoscopic jejunostomy (PEJ). These procedures are commonly performed today for patients with various chronic, traumatic, or malignant conditions and who are in need of nutritional support or decompression. Although enteral access provides many benefits, understanding its indications and limitations is critical for performing these procedures safely and effectively. This chapter provides an overview of current knowledge and practices in the rapidly evolving field of endoscopic enteral access, with emphasis on patient selection, preoperative considerations, technical conducts, and avoiding complications.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- PEG:
-
Percutaneous endoscopic gastrostomy
- PEG-J:
-
Percutaneous endoscopic gastrostomy–jejunostomy
- PEJ:
-
Percutaneous endoscopic jejunostomy
References
Ponsky JL, Gauderer MWL. Percutaneous endoscopic gastrostomy: a nonoperative technique for feeding gastrostomy. Gastrointest Endosc. 1981;27:9–11.
El-Matary W. Percutaneous endoscopic gastrostomy in children. Can J Gastroenterol. 2008;22:993–8.
Grant JP. Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy. Ann Surg. 1988;207:598–603.
Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, et al. The clinical course of advanced dementia. N Engl J Med. 2009;361:1529–38.
FOOD Trial Collaboration. Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke. 2003;34:1450–6.
Dennis MS, Lewis SC, Warlow C, FOOD Trial Collaboration. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet. 2005;365:764–72.
Broadley S, Croser D, Cottrell J, Creevy M, Teo E, Yiu D, et al. Predictors of prolonged dysphagia following acute stroke. J Clin Neurosci. 2003;10:300–5.
James A, Kapur K, Hawthorne AB. Long-term outcome of percutaneous endoscopic gastrostomy feeding in patients with dysphagic stroke. Age Ageing. 1998;27:671–6.
Dharmarajan T. Percutaneous endoscopic gastrostomy and outcome in dementia. Am J Gastroenterol. 2001;96:2556–63.
Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. In: The Cochrane Collaboration, editor. Cochrane Database Syst Rev [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2009 [cited 2014 Sep 17]. http://doi.wiley.com/10.1002/14651858.CD007209.pub2.
Sanders DS, Carter MJ, D’Silva J, James G, Bolton RP, Bardhan KD. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol. 2000;95:1472–5.
Akkersdijk WL, Roukema JA, van der Werken C. Percutaneous endoscopic gastrostomy for patients with severe cerebral injury. Injury. 1998;29:11–4.
Shepherd RW, Holt TL, Thomas BJ, Kay L, Isles A, Francis PJ, et al. Nutritional rehabilitation in cystic fibrosis: controlled studies of effects on nutritional growth retardation, body protein turnover, and course of pulmonary disease. J Pediatr. 1986;109:788–94.
Zhu Y, Shi L, Tang H, Tao G. Current considerations in direct percutaneous endoscopic jejunostomy. Can J Gastroenterol. 2012;26:92–6.
Bender JS. Percutaneous endoscopic gastrostomy placement in the morbidly obese. Gastrointest Endosc. 1992;38:97–8.
Wiggins TF, Garrow DA, DeLegge MH. Evaluation of percutaneous endoscopic feeding tube placement in obese patients. Nutr Clin Pract. 2009;24:723–7.
Schrag SP, Sharma R, Jaik NP, Seamon MJ, Lukaszczyk JJ, Martin ND, et al. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointest Liver Dis. 2007;16:407–18.
Lipp A, Lusardi G. Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy. Cochrane Database Syst Rev. 2013;11, CD005571.
Jafri NS, Mahid SS, Minor KS, Idstein SR, Hornung CA, Galandiuk S. Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy. Aliment Pharmacol Ther. 2007;25:647–56.
Kozarek RA, Ball TJ, Ryan JA. When push comes to shove: a comparison between two methods of percutaneous endoscopic gastrostomy. Am J Gastroenterol. 1986;81:642–6.
Hogan RB, DeMarco DC, Hamilton JK, Walker CO, Polter DE. Percutaneous endoscopic gastrostomy—to push or pull. Gastrointest Endosc. 1986;32:253–8.
Foutch PG, Talbert GA, Waring JP, Sanowski RA. Percutaneous endoscopic gastrostomy in patients with prior abdominal surgery: virtues of the safe tract. Am J Gastroenterol. 1988;83:147–50.
Kwon RS, Banerjee S, Desilets D, Diehl DL, Farraye FA, Kaul V, et al. Enteral nutrition access devices. Gastrointest Endosc. 2010;72:236–48.
Larson DE, Burton DD, Schroeder KW, Dimagno EP. Percutaneous endoscopic gastrostomy: indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology. 1987;93:48–52.
Taylor CA, Larson DE, Ballard DJ, Bergstrom LR, Silverstein MD, Zinsmeister AR, et al. Predictors of outcome after percutaneous endoscopic gastrostomy: a community-based study. Mayo Clin Proc. 1992;67:1042–9.
Loser C, Wolters S, Folsch UR. Enteral long-term nutrition via percutaneous endoscopic gastrostomy (PEG) in 210 patients a four-year prospective study. Dig Dis Sci. 1998;43:2549–57.
Kohli H, Bloch R. Percutaneous endoscopic gastrostomy: a community hospital experience. Am Surg. 1995;61:191–4.
Davis Jr JB, Bowden Jr TA, Rives DA. Percutaneous endoscopic gastrostomy. Do surgeons and gastroenterologists get the same results? Am Surg. 1990;56:47–51.
Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol. 2014;20:8505–24.
Longcroft-Wheaton G, Marden P, Colleypriest B, Gavin D, Taylor G, Farrant M. Understanding why patients die after gastrostomy tube insertion: a retrospective analysis of mortality. J Parenter Enteral Nutr. 2009;33:375–9.
DiSario JA, Baskin WN, Brown RD, DeLegge MH, Fang JC, Ginsberg GG, et al. Endoscopic approaches to enteral nutritional support. Gastrointest Endosc. 2002;55:901–8.
Rumalla A, Baron TH. Results of direct percutaneous endoscopic jejunostomy, an alternative method for providing jejunal feeding. Mayo Clin Proc. 2000;75:807–10.
Yamazaki T, Sakai Y, Hatakeyama K, Hoshiyama Y. Colocutaneous fistula after percutaneous endoscopic gastrostomy in a remnant stomach. Surg Endosc. 1999;13:280–2.
Patwardhan N, McHugh K, Drake D, Spitz L. Gastroenteric fistula complicating percutaneous endoscopic gastrostomy. J Pediatr Surg. 2004;39:561–4.
Kim HS, Lee DK, Baik SK, Kwon SO. Endoscopic management of colocutaneous fistula after percutaneous endoscopic gastrostomy. Endoscopy. 2002;34:430.
Sookpotarom P, Vejchapipat P, Chongsrisawat V, Mahayosnond A. Gastric volvulus caused by percutaneous endoscopic gastrostomy: a case report. J Pediatr Surg. 2005;40:e21–3.
Freeman C, Delegge MH. Small bowel endoscopic enteral access. Curr Opin Gastroenterol. 2009;25:155–9.
Potter MB, Bowers SB, Pruitt A. Internal hernia with small bowel volvulus in a patient with altered gut motility: a complication of direct percutaneous endoscopic jejunostomy. Dig Dis Sci. 2007;52:1910–3.
Sinclair J, Scolapio J, Stark M, Hinder R. Metastasis of head and neck carcinoma to the site of percutaneous endoscopic gastrostomy: case report and literature review. J Parenter Enteral Nutr. 2001;25:282–5.
Grant JP. Percutaneous endoscopic gastrostomy. Initial placement by single endoscopic technique and long-term follow-up. Ann Surg. 1993;217:168–74.
Kadakia SC, Sullivan HO, Starnes E. Percutaneous endoscopic gastrostomy or jejunostomy and the incidence of aspiration in 79 patients. Am J Surg. 1992;164:114–8.
Greif JM, Ragland JJ, Gage Ochsner M, Riding R. Fatal necrotizing fasciitis complicating percutaneous endoscopic gastrostomy. Gastrointest Endosc. 1986;32:292–4.
Cave DR, Robinson WR, Brotschi EA. Necrotizing fasciitis following percutaneous endoscopic gastrostomy. Gastrointest Endosc. 1986;32:294–6.
Chung RS, Schertzer M. Pathogenesis of complications of percutaneous endoscopic gastrostomy. A lesson in surgical principles. Am Surg. 1990;56:134–7.
Safadi BY, Marks JM, Ponsky JL. Percutaneous endoscopic gastrostomy. Gastrointest Endosc Clin N Am. 1998;8:551–68.
Gurusamy KS, Koti R, Wilson P, Davidson BR. Antibiotic prophylaxis for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) related complications in surgical patients. In: The Cochrane Collaboration, editor. Cochrane Database Syst. Rev. [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2013 [cited 2014 Sep 17]. http://doi.wiley.com/10.1002/14651858.CD010268.pub2.
Anderson MA, Ben-Menachem T, Gan SI, Appalaneni V, Banerjee S, Cash BD, et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc. 2009;70:1060–70.
Kanie J, Akatsu H, Suzuki Y, Shimokata H, Iguchi A. Mechanism of the development of gastric ulcer after percutaneous endoscopic gastrostomy. Endoscopy. 2002;34:480–3.
Dwyer KM, Watts DD, Thurber JS, Benoit RS, Fakhry SM. Percutaneous endoscopic gastrostomy: the preferred method of elective feeding tube placement in trauma patients. J Trauma. 2002;52:26–32.
Wiesen AJ, Sideridis K, Fernandes A, Hines J, Indaram A, Weinstein L, et al. True incidence and clinical significance of pneumoperitoneum after PEG placement: a prospective study. Gastrointest Endosc. 2006;64:886–9.
Nazarian A, Cross W, Kowdley GC. Pneumoperitoneum after percutaneous endoscopic gastrostomy among adults in the intensive care unit: incidence, predictive factors, and clinical significance. Am Surg. 2012;78:591–4.
Wojtowycz M, Arata J, Micklos T, Miller F. CT findings after uncomplicated percutaneous gastrostomy. Am J Roentgenol. 1988;151:307–9.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 SAGES
About this chapter
Cite this chapter
Tsuda, S. (2016). Enteral Access: Percutaneous Endoscopic Gastrostomy, Gastrostomy–Jejunostomy, and Jejunostomy. In: Kroh, M., Reavis, K. (eds) The SAGES Manual Operating Through the Endoscope. Springer, Cham. https://doi.org/10.1007/978-3-319-24145-6_10
Download citation
DOI: https://doi.org/10.1007/978-3-319-24145-6_10
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-24143-2
Online ISBN: 978-3-319-24145-6
eBook Packages: MedicineMedicine (R0)