From the Guidelines
Percutaneous endoscopic gastrostomy (PEG) tube is indicated for patients who require long-term enteral nutrition (typically more than 4 weeks) with a functioning gastrointestinal tract and inability to maintain adequate oral intake, as stated in the most recent guideline update 1. The indications for PEG tube placement include impaired nutrient intake due to various conditions such as neurologic disease, postcerebrovascular accident, motor neuron disease, multiple sclerosis, movement disorder, unconscious patient/ventilated patient, cerebral palsy, select cases of dementia, upper gastrointestinal obstruction/motility disorder, head and neck cancer, head, maxillofacial, mandibular, dental, or neck trauma, radiation stomatitis, and esophageal cancer 1. Key considerations for PEG tube placement involve evaluating the patient's swallowing function, nutritional status, and overall prognosis, while also considering contraindications such as severe coagulopathy, peritonitis, ascites, peritoneal carcinomatosis, and morbid obesity 1. The procedure for PEG tube placement involves endoscopic guidance to insert the feeding tube directly through the abdominal wall into the stomach, and it is preferred over nasogastric tubes for long-term feeding due to its comfort, reduced aspiration risk, and improved mobility and quality of life while ensuring consistent nutritional support 1. Some specific conditions that may require PEG tube placement include:
- Neurological disorders affecting swallowing, such as stroke, Parkinson's disease, ALS, and dementia
- Head and neck cancers
- Severe facial trauma
- Prolonged unconsciousness
- Critical illnesses requiring extended ventilator support
- Upper gastrointestinal obstructions
- Chronic aspiration
- Severe gastroparesis It is essential to weigh the benefits and risks of PEG tube placement and consider the patient's individual needs and circumstances, as well as the potential complications and contraindications, as outlined in the recent clinical practice update 1.
From the Research
Indications for Peg Tube
- Neurogenic dysphagia is the most common indication for PEG tube placement, followed by obstructive causes such as head and neck tumors 2
- PEG tube placement is also indicated for patients with neurological conditions, such as amyotrophic lateral sclerosis, Parkinson's disease, and dementia 3
- Enteral feeding and stomach decompression are the two main indications for PEG tube placement 4
- PEG tube placement can be beneficial in acutely ill cognitively intact elderly patients for short-term nutritional support 5
Patient Selection
- Patients with a functional gastrointestinal system who require long-term enteral nutrition are suitable for PEG tube placement 4
- Patients with persisting neurological dysphagia can benefit from PEG tube placement 6
- Cognitively intact elderly patients with acute illnesses can also benefit from short-term PEG tube placement 5
Contraindications
- Absolute contraindications for PEG tube placement include limited life expectancy, technical difficulties, pharyngeal/esophageal obstruction, peritonitis, and uncorrectable coagulopathy 2
- Distal enteral obstruction, severe uncorrectable coagulopathy, and hemodynamic instability are also absolute contraindications for PEG tube placement 4