Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement

Updated: Apr 11, 2017
  • Author: Gaurav Arora, MD, MS; Chief Editor: Danny A Sherwinter, MD  more...
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Overview

Background

Percutaneous endoscopic gastrostomy (PEG) is a method of placing a tube into the stomach percutaneously, aided by endoscopy. This technique was first described by Gauderer in 1980. [1]  Different variations of the technique include the pull (Ponsky), push (Sachs-Vine), introducer (Russell), and Versa (T-fastener) methods. Of these, the pull method is the most commonly used and is described in this article. PEG tube placement is one of the most commonly performed endoscopic procedures at present, and an estimated 100,000-125,000 are performed annually in the United States. [2, 3, 4, 5, 6]

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Indications

Broadly, the two main indications for PEG tube placement are as follows:

  • Establishment of enteral access for feeding
  • Gut decompression

Patients who are unable to move food from their mouth to their stomach are the ones who commonly need PEG tube placement. This includes those with neurologic disorders such as stroke, cerebral palsy, brain injury, amyotrophic lateral sclerosis, [7] and impaired swallowing. [8]  In addition, patients who have trauma, cancer, or recent surgery of the upper gastrointestinal tract or the respiratory tract may require this procedure to maintain nutritional intake.

Gut decompression may be needed in patients who have abdominal malignancies causing gastric outlet or small-bowel obstruction or ileus.

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Contraindications

Absolute contraindications for PEG tube placement include the following:

  • Uncorrected coagulopathy or thrombocytopenia
  • Severe ascites
  • Hemodynamic instability
  • Intra-abdominal perforation
  • Active peritonitis
  • Abdominal-wall infection at the selected site of placement
  • Gastric outlet obstruction (if the PEG tube is being placed for feeding)
  • Severe gastroparesis (if the PEG tube is being placed for feeding)
  • History of total gastrectomy
  • Lack of informed consent for the procedure

Relative contraindications for PEG tube placement include the following:

  • Presence of oropharyngeal or esophageal malignancy (potential risk of seeding of the PEG tract)
  • Hepatomegaly
  • Esophageal malignancy that will require the use of the stomach as a conduit for recostruction followig definitive esophageal resection 
  • Portal hypertension with gastric varices
  • History of prior abdominal surgical procedures (possible presence of adhesions and bowel interposition)
  • Peritoneal dialysis
  • History of partial gastrectomy

Opinions have varied as to whether placement of a ventriculoperitoneal shunt constitutes a contraindication for PEG. A systematic review by Oterdoom et al concluded that placement of such a shunt in conjunction with a PEG tube was associated with a high but acceptable shunt complication rate and that shunt insertion therefore should not be considered a contraindication to PEG. [9] They suggested that the PEG tube should be placed after the ventriculoperitoneal shunt but did not conclusively establish an optimal interval.

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