Percutaneous Endoscopic Gastrostomy

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • Not able to return to normal alimentation
  • Long-term feeding access
  • Need of upper GI tract emptied directly through the stomach
  • Long-term mechanical ventilation
  • Severe facial trauma or an inability to swallow
  • Patients with malnutrition
CONTRAINDICATIONS
  • Comatose patients
  • Gastroparesis, gastric outlet obstruction, or gastric resection
  • Gastric varices
  • Coagulopathy
  • Massive ascites

Clinical Pearls: Previous operation, obesity, and lack of transillumination are not absolute contraindications.
EQUIPMENT
  • Esophagogastroduodenoscope
  • PEG kit

Clinical Pearls: We use two types of PEG tubes. The first one is the Bard PEG tube, which has a very flexible, soft disc as its bumper. It has many benefits, including high patient tolerance and the ability to extract the PEG in the office or at the bedside.

Clinical Pearls: The second PEG tube that we use is the Kendall Dobbhoff PEG tube. It has a fairly firm, plastic bumper. It is very safe to use in the obese, confused, or agitated patient as it is slightly more difficult to pull out through the gastric wall. It therefore requires repeat endoscopy to extract this PEG.
ANATOMY
  • The anterior abdominal wall is made up of many layers. They are (superficial to deep) skin, fascia (Camper's and Scarpa's fascia), three muscle layers—external oblique, internal oblique, and transversus abdominis, followed by the peritoneum. All of these layers, plus the anterior wall of the stomach, are traversed in the placement of a successful PEG tube.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Best to irrigate the tube twice a day.
  • The gastrostomy tube can be used for medications and feeding on the day of the procedure.
  • The patient should be seen in clinic 5 to 7 days after placement for follow-up and loosening of the disc.
COMPLICATIONS
  • Infection
  • Intragastric bleeding
  • PEG tube displacement
  • Gastric or colonic perforation
  • Gastroesophageal reflux disease
  • Aspiration
  • Pneumonia
  • Skin irritation
RESULT ANALYSIS
  • PEG tube placement is a safe, minimally invasive technique that allows for the feeding or decompression of the stomach in patients with a functional GI tract. It is widely used in the very sick, elderly patient with numerous comorbid diseases.
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