From the Guidelines
Imaging to evaluate PEG tube placement or obstruction is typically performed using radiographic confirmation.
Key Points
- Radiographic confirmation of tube placement should be performed for all blind enteric placements and if there is concern about misplacement after guided placement 1.
- Endoscopic guidance can also be used to confirm the placement of the PEG tube, and is often used in conjunction with radiographic imaging 1.
- The use of imaging to evaluate PEG tube placement or obstruction is an important part of ensuring the safe and effective use of these devices.
- Radiographic imaging is the most commonly used method for evaluating PEG tube placement, and can help to identify any potential complications, such as misplacement or obstruction of the tube.
- The American Gastroenterological Association (AGA) recommends the use of radiographic imaging to confirm the placement of PEG tubes, particularly in cases where there is concern about misplacement or obstruction 1.
Placement Techniques
- PEG tubes can be placed using a variety of techniques, including the Ponsky technique, which involves the use of a guide wire and a gastrostomy tube that is pulled through the abdominal wall and into the stomach 1.
- The Russell technique, also known as the "introducer" technique, involves the use of a T-tack gastropexy and a guide wire to place the PEG tube 1.
- Transabdominal insertion is another technique that can be used to place PEG tubes, and involves the use of a needle and a guide wire to place the tube through the abdominal wall and into the stomach 1.
From the Research
Imaging Modalities for Evaluating PEG Tube Placement
To evaluate the placement or obstruction of a percutaneous endoscopic gastrostomy (PEG) tube, various imaging modalities can be utilized. These include:
- Computed Tomography (CT) scans: CT guidance can be used to ensure accurate placement of the PEG tube, especially in patients with altered upper gastrointestinal anatomy 2, 3, 4.
- CT fluoroscopy: This modality can be used to guide the placement of the PEG tube in real-time, allowing for more precise placement and reducing the risk of complications 3.
- Abdominal radiography: While not as accurate as CT scans, abdominal radiographs can still be used to evaluate the position of the PEG tube and identify potential complications 4.
- Magnetic positional imaging: This technique uses electronic three-dimensional imaging to aid in the accurate placement of the PEG tube, reducing the risk of serious complications 5.
Advantages and Limitations of Each Modality
Each imaging modality has its advantages and limitations. For example:
- CT scans provide high-resolution images and can accurately guide the placement of the PEG tube, but may not be available in all settings 2, 3, 4.
- CT fluoroscopy allows for real-time guidance, but may require specialized equipment and training 3.
- Abdominal radiography is widely available, but may not provide sufficient detail to accurately evaluate the position of the PEG tube 4.
- Magnetic positional imaging is a relatively new technique that shows promise, but requires further study to fully understand its benefits and limitations 5.
Clinical Applications
These imaging modalities can be used in a variety of clinical settings, including:
- Initial placement of the PEG tube: Imaging guidance can help ensure accurate placement and reduce the risk of complications 2, 3, 4, 5.
- Evaluation of PEG tube obstruction: Imaging modalities can help identify the cause of obstruction and guide treatment 6.
- Troubleshooting: Imaging can be used to identify and address potential complications, such as tube misplacement or leakage 6.