An overview of percutaneous endoscopic gastrostomy tube placement in the intensive care unit

Abstract

Critically ill patients are at increased risk for malnutrition as they often have underlying acute and chronic illness, stress related catabolism, decreased appetite, trauma and ongoing inflammation. Malnutrition is recognized as a leading cause of adverse outcomes, higher mortality, and increased hospital costs. Percutaneous endoscopic gastrostomy (PEG) tubes provide a safe and effective route to provide supplemental enteral nutrition to these patients. PEG placement has essentially replaced surgical gastrostomy as the modality of choice for longer term feeding in patients. This is a highly prevalent procedure with 160,000 to 200,000 PEG procedures performed each year in the United States. The purpose of this review is to provide an overview of current knowledge and practice standards with regards to placement of PEG tube in the Intensive Care Unit (ICU). When a patient is considered for a PEG tube, it is important to evaluate the treatment alternatives and identify the best option for each patient. In this review, we provide the advantages and disadvantages of various feeding modalities and devices. We review the indications and contraindications for PEG tube placement as well as the risks of this procedure. We then describe in detail the per-oral pull, per-oral push, and direct percutaneous techniques for PEG tube placement. Additionally, we review the feasibility of having interventional pulmonologists place PEG tubes in the ICU.

Severe Gastrointestinal Bleeding Following Gastrostomy Tube Replacement: A Case of an Unusual Presentation of Enterocutaneous Fistula

“…In the United States, an estimated 160,000 to 200,000 PEG procedures occur each year [ 9 ]. Recovery from these procedures is relatively fast but can be delayed in patients with comorbidities [ 10 ].…”

Interventional Pulmonology and the Esophagus: Tracheostomy and Percutaneous Endoscopic Gastrostomy Placement

“…The balloon is collapsed, and the wire is pulled out through the mouth. The PEG tube is then placed via push technique 44 ( Fig. 8 ).…”

Impact of percutaneous endoscopic gastrostomy on pediatric bone marrow transplantation outcomes: Retrospectice single‐center cohort study

“…PEG is also beneficial for gastric decompression, especially for patients with ileus. 13,14 Children after aHSCT frequently experience damage of the intestines that may also manifest as ileus. In addition, PEG is recommended for medicine administration by European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines to ensure better treatment adherence.…”

“…PEG is also beneficial for gastric decompression, especially for patients with ileus 13,14 . Children after aHSCT frequently experience damage of the intestines that may also manifest as ileus.…”