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“Resident Reminders”
Practice Guideline Highlights in Gastroenterology
q PEG may not be appropriate in patients with rapidly progressive or incurable diseases and should not be placed when it is expected that regular feedings will resume within 30 days
q PEG or even small bowel feeding does not decrease aspiration or pneumonia
q PEG should not be placed in infected or bacteremic patients with fever or leukocytosis
q After placement, PEG can be used within 3-4 hours
q If the PEG tube is removed inadvertently during the first 14 days after placement, do not attempt to re-insert the tube. Consult Gastroenterology and Surgery for advice.
q If the PEG tube is removed inadvertently after it has been in place for more than 14 days, it should be replaced within 1 to 2 hours. Consult Gastroenterology for advice. If specialty care is not readily available, carefully insert a lubricated 16 or 18 gauge Foley catheter through the PEG tube tract.
q During feeding, the patient must have the head elevated
q Complications
ü Minor 13-43%
ü Major 0.4-8.4%
ü Mortality 0-2%
q Contraindications
ü Inability to bring the stomach to the anterior gastric wall
ü Pharyngeal or esophageal obstruction
ü Uncorrectable coagulopathy
ü Prior gastric surgery
ü Ascites, obesity, hepatomegaly may prevent PEG placement
ü Gastric neoplasm or inflammation
Additional Reading:
American Society for
Gastrointestinal Endoscopy. Role of endoscopy in enteral feeding. Gastrointest
Endosc 2002;55:794-797
Kirby DF, Delegge MH, Fleming CR. American Gastroenterological Association
technical review on tube feeding for enteral nutrition. Gastroenterology
1995;108:1282-301.
Pofahl WE, Ringold F. Management of early dislodgment of percutaneous endoscopic
gastrostomy tubes. Surg Laparoscopy Endosc Percutaneous Tech 1999;9:253-6.
