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Concept: Gastrostomy


No analysis of the long-term performance of percutaneous endoscopic gastrostomy (PEG) replacement tubes was identified. A randomized partially blinded trial was designed hypothesizing that clinically relevant limitations of the tubes would be identified.

Concepts: Randomized controlled trial, Esophagogastroduodenoscopy, Jury, Percutaneous endoscopic gastrostomy, Gastrostomy, The Tubes


BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is widely accepted as the preferred procedure to establish long-term enteral feeding. OBJECTIVE: To learn the long-term outcomes of the patients who have undergone PEG placement, we reviewed our experience with children who underwent this procedure in our institute. METHODS: A total of 83 pediatric patients (42 males and 41 females), who were aged from 3 months to 20 years, underwent PEG insertion in National Taiwan University Hospital from January 2000 to April 2011. The underlying diseases of the patients receiving PEG were neurological dysfunction (n = 67), metabolic disorders (n = 9), gastrointestinal disease (n = 2), and congenital heart disease (n = 1). This procedure was performed under intravenous sedation or under general anesthesia. Prophylactic antibiotics were administered for 1 day. Tube feeding began 24 hours after the PEG placement. The body weight of the patients was recorded 1 day before PEG placement and at least 6 months after PEG placement. RESULTS: The weight-for-age Z-score before and at 6 months after PEG placement were -1.5 ± 2.0 and -0.9 ± 2.1, respectively, which was statistically significant (paired t test, p = 0.006). The catch-up growth was recorded after PEG placement. Complications of PEG in our patients included cellulitis at the gastrostomy wound (n = 14), dislodgement of the tube (n = 17), and persistent gastrocutaneous fistula (n = 3). The PEG tube was removed permanently in seventeen patients because they resumed an adequate oral intake. During the follow-up period, 14 patients died of an underlying disease or infection. CONCLUSION: Our experience confirmed that PEG placement is a good long-term route for nutritional supply with no serious complications in children.

Concepts: Feeding tube, Anesthesia, Sedation, Esophagogastroduodenoscopy, Endoscopy, Percutaneous endoscopic gastrostomy, Gastrostomy, Enteral feeding


Despite guidelines, long-term enteral nutrition (EN) through percutaneous endoscopic gastrostomy (PEG) is often prescribed to older individuals with dementia and eating problems (refusal to eat or dysphagia). The aim of this prospective observational non-randomized un-blinded study was to assess the role of this procedure on risk of mortality.

Concepts: Nutrition, Eating, Food, Dieting, Esophagogastroduodenoscopy, Percutaneous endoscopic gastrostomy, Gastrostomy, Steely Dan


Chemoradiotherapy (CRT) has evolved as the preferred organ preservation strategy in the treatment of locally advanced head and neck cancer (HNC). This approach increases malnutrition, and thus, establishing a direct enteral feeding route is essential. To evaluate the usefulness of prophylactic percutaneous endoscopic gastrostomy (PEG) in HNC patients receiving definitive CRT, we performed a prospective evaluation of HNC patients over a 6-month period. Patients and tumor characteristics, nutritional status 30 days after PEG insertion and technique complications were evaluated. We also assessed the long-term PEG usage. Forty-seven PEGs were placed and only 2 patients did not use it. The mean time of PEG use was 131 days (4-255) and mean duration of exclusive utilization was 71 days (4-180). On 30th day after procedure, 34/45 (76 %) patients had lost weight, but only 10/45 (22 %) patients had lost more than 10 % of their initial weight. The most frequent complications were minor peristomal infections, which were correlated with proton-pump inhibitor use before PEG placement (OR 3.91, 95 % CI 1.01-15.2, and p = 0.049). One year later, 19 % of patients in remission continue needing PEG. Enteric nutritional support is essential during and after CRT in HNC patients. Most patients lost weight even with PEG. One-fifth of patients in remission required long-term PEG utilization.

Concepts: Head and neck anatomy, Head and neck, Nutrition, Obesity, Preference, Percutaneous endoscopic gastrostomy, Gastrostomy, Enteral feeding


With the notable exceptions of dementia, stroke, and motor neuron disease, relatively little is known about the safety and utility of percutaneous endoscopic gastrostomy (PEG) tube insertion in patients with neurodegenerative disease. We aimed to determine the safety and utility of PEG feeding in the context of neurodegenerative disease and to complete a literature review in order to identify whether particular factors need to be considered to improve safety and outcome.

Concepts: Stroke, Neurology, Feeding tube, Esophagogastroduodenoscopy, Motor neuron, Percutaneous endoscopic gastrostomy, Gastrostomy, Enteral feeding


To evaluate physician knowledge and perceptions about the American Board of Internal Medicine/American Geriatrics Society (ABIM/AGS) Choosing Wisely recommendations regarding percutaneous endoscopic gastrostomy (PEG) in individuals with advanced dementia.

Concepts: Medicine, Physician, Feeding tube, Percutaneous endoscopic gastrostomy, Gastrostomy, Physician assistant, Enteral feeding


Percutaneous endoscopic gastrostomy (PEG) is now commonly used in long-term care and community settings. However, regional variations exist in the acceptability of PEG tube feeding with long-term nasogastric feeding still commonplace in many Asian nations.

Concepts: Feeding tube, Qualitative research, Quantitative research, Esophagogastroduodenoscopy, Endoscopy, Percutaneous endoscopic gastrostomy, Gastrostomy, Enteral feeding


This ESPGHAN position statement provides a comprehensive guide for healthcare providers to manage percutaneous endoscopic gastrostomy tubes (PEG) in a safe, effective and appropriate way.

Concepts: Health care provider, Esophagogastroduodenoscopy, Percutaneous endoscopic gastrostomy, Gastrostomy


ABSTRACT BACKGROUND: Prior to the 1980’s permanent feeding tube placement was limited to an open surgical procedure until Dr.’s Gauderer and Ponsky described the safe placement of percutaneous endoscopic gastrostomy (PEG) tubes. This procedure has since expanded beyond the realm of surgeons to include gastroenterologists, thoracic surgeons and interventional radiologists. In some academic centers interventional pulmonologists (IP) have begun performing this procedure. We describe the safety and feasibility of PEG placement by IP in a critically ill population. METHODS: A review of prospectively collected data of medical intensive care unit patients undergoing PEG tube placement from 2003 to 2007 at a tertiary care center was performed. Inclusion criteria included all performed or attempted PEG insertions by the IP team. Data was collected for mortality, PEG removal rate, total number of days with PEG, and complication rates. Follow-up included a patient’s hospital stay as well as phone contact after discharge. Procedural and long-term PEG related complications were recorded. RESULTS: 72 patients were studied. PEG insertion was successfully completed in 70 (97.2%) patients, with follow-up data in 69/70 patients. Thirty-day mortality was 11.7%. No deaths or immediate complications were attributed to PEG placement. PEG removal occurred in 27 patients, with the median time to removal being 76 days. CONCLUSION: Bedside PEG placement can be performed safely and effectively by trained IP. As percutaneous tracheostomy is currently performed by IP, the ability to perform both PEG and tracheostomy placement at the same time has the potential for decreased costs, anesthesia exposure, procedural times, ventilator times, and ICU days.

Concepts: Medicine, Hospital, Surgery, Physician, Feeding tube, Percutaneous endoscopic gastrostomy, Gastrostomy, Enteral feeding


Buried bumper syndrome is a rare complication of percutaneous endoscopic gastrostomy. Complete BBS without visible parts of the inner bumper is a challenge for endoscopic treatment.

Concepts: Endoscopic retrograde cholangiopancreatography, Esophagogastroduodenoscopy, Endoscopy, Rare, Percutaneous endoscopic gastrostomy, Gastrostomy