Percutaneous Endoscopic Gastrostomy (PEG)
What is it?
This procedure entails placing a tube into the stomach to connect the gastric cavity with the outside. This procedure allows the delivery of drugs, food and liquids in patients who are unable to feed themselves orally, as an alternative to parenteral or enteral feeding by nasal tube (often not recommended for long time).
When is this exam indicated?
Some diseases (neurological, infectious, tumoral) may cause a temporary or permanent inability to feed orally. In these cases, it is necessary to take a parenteral nutrition (infusion into a vein), or enteral, by placing a tube through the nose to the stomach (naso-gastric) or intestine (naso-digiunal). However, both of these solutions present numerous problems when feeding must last for long periods. In such a situation, today, it is possible to perform, precisely, the positioning of a gastrostomy by endoscopy. The implantation of a PEG in no way excludes the oral nutrition of the patient.
How is it performed?
The procedure is performed under moderate sedation or deep sedation, in order to cause the least possible discomfort to the patient. An antibiotic prophylaxis is usually administered before the procedure, to prevent infectious complications from the future gastrostomy. A probe, the gastroscope, equipped with a camera at the tip, is used and is introduced through the mouth into the stomach. The light from the gastroscope in the stomach is reflected on the wall of the abdomen. At this point, the doctor after performing a local anesthesia of the skin, makes a small needle enter the stomach through the wall of the abdomen. Through the needle a thin wire is run, which is grasped in the stomach through the gastroscope and taken out of the mouth, in order to introduce the small tube, which will allow the feeding and the delivery of medicaments.
Contraindications
Complications: PEG is a safe procedure, with a low rate of major complications (1-4%). The most frequent complications are wound infection, which is rarely severe, or bleeding at the site of probe placement. Additional, less frequent complications include gastrointestinal bleeding, peritonitis, sepsis, intestinal perforation, abdominal wall abscess, or sedation-related complications.
Contraindications: Possible contraindications are esophageal stenosis or, more generally, the inability to reach the gastric lumen with the gastroscope. Other contraindications to the procedure are: severe coagulopathy, massive ascites, major gastroesophageal reflux, portal hypertension with esophageal varices, gastric cancer, gastric ulcer, severe obesity and peritoneal carcinosis. Previous stomach surgery or extensive abdominal scarring are relative contraindications (feasibility of the procedure must be evaluated on a case-by-case basis).
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