Hence, PEG tube insertion is usually considered in patients at risk for moderate to severe malnourishment within 2-3 wk of nasoenteric tube feeding. Nasoenteric tubes (nasogastric, nasoduodenal and nasojejunal) are usually reserved for short-term (< 30 d) enteral feeding in patients with intact protective airway reflexes.Ĭompared to PEG tubes, nasoenteric tubes result in more complications (irritation, ulceration, bleeding, esophageal reflux and aspiration pneumonia), lower subjective comfort and even lower feeding efficacy. To maintain or establish adequate nutrition, enteral feeding is necessary for patients with insufficient oral intake. However, longer fasting periods, depending on the patient’s baseline health status, can be unfavorable. Patients with adequate baseline nutritional status can tolerate up to 10 d of partial fasting (with maintenance fluids) before severe protein catabolism occurs. This article reviews the current knowledge on PEG in the medical literature. PEG is currently the method of choice for medium- and long-term enteral feeding. Due to low cost, less invasive and no need for general anesthesia in most cases (which is a challenging factor in debilitated patients in whom gastrostomy tubes are most commonly placed), PEG is considered to be a better choice for the introduction of a feeding tube than surgical methods. Percutaneous endoscopic gastrostomy (PEG) was first introduced in 1980 by the application of endoscopy to insert a feeding tube into the stomach. Access to insert the gastrostomy tube can be achieved by the use of endoscopy, radiological imaging, or surgical techniques (open or laparoscopic). Gastric feeding is the most common type of enteral feeding. Tube feeding through the GI tract is mainly considered in patients with insufficient oral intake who have a functional GI system and tube insertion into their alimentary tract can be safely maintained. Moreover, it has been shown that enteric feeding can decrease the risk of bacterial translocation and corresponding bacteremia. Enteral feeding is usually the preferred method over parenteral feeding in patients with a functional gastrointestinal (GI) system due to the associated risks of the intravenous route, higher cost and inability of parenteral nutrition to provide enteral stimulation and subsequent compromise of the gut defense barrier. The primary indication for enteral and parenteral feeding is the provision of nutritional support to meet metabolic requirements for patients with inadequate oral intake. Despite the mentioned PEG tube placement complications, this procedure has gained worldwide popularity as a safe enteral access for nutrition in patients with a functional gastrointestinal system. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the “pull” technique being the most common method. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition.
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