Complications related to Percutaneous Endoscopic Gastrostomy (PEG) tubes. A comprehensive clinical review

Department of Surgery, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA.
Journal of gastrointestinal and liver diseases: JGLD (Impact Factor: 2.2). 01/2008; 16(4):407-18.
Source: PubMed

ABSTRACT Percutaneous endoscopic gastrostomy (PEG) has become the modality of choice for providing enteral access to patients who require long-term enteral nutrition. Although generally considered safe, PEG tube placement can be associated with many potential complications. This review describes a variety of PEG tube related complications as well as strategies for complication avoidance. In addition, the reader is presented with a brief discussion of procedures, techniques, alternatives to PEG tubes, and related issues. Special topics covered in this review include PEG tube placement following previous surgery and PEG tube use in pregnancy.

Download full-text


Available from: Rohit Sharma, Sep 23, 2014
1,252 Reads
  • Source
    • "This paper demonstrates the application of a fully controllable electropermanent magnetic coupling system between a permanent magnet inside of the porcine stomach and an electropermanent magnet (EPM) for external manipulation. The current realization provides a mechanical working channel alleviating possible ambiguity in current procedures that necessitate trans-abdominal incisions, such as is typical in the placement of percutaneous endoscopic gastrostomy (PEG) tubes [23]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The use of magnets for anchoring of instrumentation in minimally invasive surgery and endoscopy has become of increased interest in recent years. Permanent magnets have significant advantages over electromagnets for these applications; larger anchoring and retraction force for comparable size and volume without the need for any external power supply. However, permanent magnets represent a potential hazard in the operating field where inadvertent attraction to surgical instrumentation is often undesirable. The current work proposes an interesting hybrid approach which marries the high forces of permanent magnets with the control of electromagnetic technology including the ability to turn the magnet off when necessary. This is achieved through the use of an electropermanent magnet, which is designed for surgical retraction across the abdominal and gastric walls. Our electropermanent magnet, which is hand-held and does not require continuous power, is designed with a centre lumen which may be used for trocar or needle insertion. The device in this application has been demonstrated successfully in the porcine model where coupling between an intraluminal ring magnet and our electropermanent magnet facilitated guided insertion of an 18Fr Tuohy needle for guidewire placement. Subsequent investigations have demonstrated the ability to control the coupling distance of the system alleviating shortcomings with current methods of magnetic coupling due to variation in trans-abdominal wall thicknesses. With further refinement, the magnet may find application in the anchoring of endoscopic and surgical instrumentation for minimally invasive interventions in the gastrointestinal tract.
    IEEE transactions on bio-medical engineering 10/2014; 62(3). DOI:10.1109/TBME.2014.2366032 · 2.35 Impact Factor
  • Source
    • "Percutaneous endoscopic gastrostomy (PEG) tube placement is most commonly performed for long- term enteral feeding access and/or gastric decompression.1 The PEG procedure was first described by Gauderer and colleagues in 1980 as an effective method of enteral feeding and as an alternative to surgical gastrostomy insertion.2,3 The most frequent indications for PEG include cerebrovascular disease (CVD), motor-neuron disease (MND), cancer, and trauma to the head and neck.4–7 "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND / OBJECTIVES The aim of this study was to perform a retrospective analysis characterizing patients receiving tube feeding following percutaneous endoscopic gastrostomy ( PEG) tube placement between 2004 and 2012 at Erciyes University Hospital in Turkey. METHODS Patients above the age of 18 years, who required long term enteral tube feeding were studied. All PEGs were performed using the pull-through technique by one experienced endoscopist Demographic, clinical outcomes, and PEG-related complication data were collected. RESULTS Of the 128 subjects studied, 91 were male (71%) and 37 were female (29%). The mean age of this patient population was 54±19 years. The most common reason for PEG tube insertion was inability to consume oral diet due to complications of cerebrovascular disease (CVD; 27%), while cerebral hypoxia, occuring after non-neurological medical disorders, was the second most common indication (23%). A total of 70 patients (55%) had chronic comorbidities, with hypertension the most common (20%). The most common procedure related complication was insertion site bleeding, which occurred in 4 % of patients. Long term complications, during one year were insertion site cellulitis, gastric contents leakage, and peristomal ulceration occurred in 14%, 5%, and 0.5% of patients, respectively. There were no PEG insertion-related mortalities; one-year mortality was unrelated to the indication for PEG tube insertion. CONCLUSIONS PEG tube insertion was a safe method to provide enteral access for nutrition support in this hospitalized patient population.
    European journal of clinical nutrition 02/2014; 68(4). DOI:10.1038/ejcn.2014.11 · 2.71 Impact Factor
  • Source
    • "Serious complications had been reported related to percutaneous method, such as massive bleeding, and tract disruption (5, 8). Complications of endoscopic removal of PEG tube has been also reported, such as upper airway obstruction and esophageal mucosal injury (7). "
    [Show abstract] [Hide abstract]
    ABSTRACT: When replacing percutaneous endoscopic gastrostomy (PEG) tubes, an internal bolster may be retrieved either percutaneously or endoscopically. The aim of this study was to compare the complications of percutaneous and endoscopic method during PEG tube replacement. The medical records of 330 patients who received PEG tube replacement were retrospectively analyzed. According to the removal method of internal bolster, we categorized as endoscopic group and percutaneous group. Demographic data, procedure-related complications and risk factors were investigated. There were 176 cases (53.3%) in endoscopic group and 154 cases (46.7%) in percutaneous group. The overall immediate complication rate during PEG tube replacement was 4.8%. Bleeding from the stoma (1.3%) occurred in percutaneous group, whereas esophageal mucosal laceration (7.4%) and microperforation (0.6%) occurred in endoscopic group. The immediate complication rate was significantly lower in the percutaneous method (OR, 6.57; 95% CI, 1.47-29.38, P=0.014). In multivariate analysis, old age was a significant risk factor of esophageal laceration and microperforation during PEG tube replacement (OR, 3.83; 95% CI, 1.04-14.07, P=0.043). The percutaneous method may be more safe and feasible for replacing PEG tubes than the endoscopic method in old patients.
    Journal of Korean medical science 12/2013; 28(12):1781-7. DOI:10.3346/jkms.2013.28.12.1781 · 1.27 Impact Factor
Show more