Percutaneous Endoscopic Gastrostomy: Insertion and Management

Abstract

Percutaneous endoscopic gastrostomy (PEG) is the modality of choice for long-term enteral feeding in patients in whom oral intake is challenging. Compared with parenteral nutrition, gastrostomy feeding is the preferred choice for sustained nutritional support. Delivery of nutrients directly to the gastrointestinal tract and enhanced cellular immunity associated with this approach are clinically beneficial to patients. Endoscopic gastrostomy is favored for its high clinical success rates and economic advantages and is associated with minor discrepancies with regard to morbidity, mortality, and tube function compared with surgical gastrostomy. PEG procedures can be broadly classified into the pull- and push-types. Although PEG is a comparatively safe procedure, high risk of bleeding is a well-known complication of PEG placement, which necessitates prophylactic antibiotic therapy and careful periprocedural management in patients who receive antiplatelet and anticoagulant agents. Tube dislodgement, peristomal leakage, or infection following PEG placement may require tube replacement or removal. In this review, we investigated the concerns associated with early vs. delayed feeding in concordance with current guidelines. We also describe the indications for PEG tube insertion, post-procedural care strategies, and management of complications.