From the Guidelines
Percutaneous endoscopic gastrostomy (PEG) tubes are indicated for patients requiring long-term enteral nutrition who have a functioning gastrointestinal tract but cannot maintain adequate oral intake, while PEG-J tubes are considered for patients at high risk of aspiration, those with gastroparesis, gastric outlet obstruction, or severe gastroesophageal reflux disease, as stated in the most recent guideline by 1. The indications for PEG tubes include:
- Neurological conditions affecting swallowing, such as stroke, dementia, and Parkinson's disease
- Head and neck cancers
- Prolonged critical illness
- Esophageal stricture
- Esophageal dysmotility
- Chronic intestinal pseudo-obstruction PEG-J tubes, on the other hand, are indicated for:
- Altered intestinal anatomy
- Bariatric or foregut surgery with impaired intake
- Psychiatric disorder
- Anorexia nervosa
- Increased metabolic requirements
- Critical illness
- Cancer
- Burn/trauma
- Cystic fibrosis/chronic lung disease
- Inflammatory bowel disease
- Liver disease
- Pancreatitis
- Renal disease As noted in 1, the decision between PEG and PEG-J should be individualized based on the patient's specific clinical condition, aspiration risk, and gastrointestinal anatomy and function. The use of PEG-J tubes may be beneficial in reducing aspiration risk and is suitable for patients who cannot tolerate gastric feeding, as mentioned in 1 and 1. However, PEG-J tubes have higher complication rates, including tube migration, clogging, and mechanical failure, and require more maintenance compared to standard PEG tubes, as reported in 1 and 1. In nonintubated patients, flexible tube placement via the nasal route is preferred for short-term enteral access, while percutaneous tube placement is typically reserved for individuals who are expected to require enteral access for 4 or more weeks, as stated in 1. Overall, the choice between PEG and PEG-J tubes should prioritize the patient's specific needs and clinical condition, with consideration of the potential benefits and risks of each option, as discussed in 1, 1, and 1.
From the Research
Indications for PEG and PEG-J Tubes
- The primary indications for Percutaneous Endoscopic Gastrostomy (PEG) tube placement are enteral feeding and stomach decompression 2.
- PEG tubes are preferred for patients with a functional gastrointestinal system who require long-term enteral nutrition 2.
- For patients requiring long-term (>4 weeks) jejunal nutrition, jejunal medication delivery, or decompression, a percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) or a direct percutaneous endoscopic jejunostomy (DPEJ) may be indicated 3.
- PEG-J is the preferred option if a PEG tube is already in place or if simultaneous gastric decompression and jejunal nutrition are needed 3.
Contraindications for PEG and PEG-J Tubes
- Absolute contraindications for PEG tube placement include distal enteral obstruction, severe uncorrectable coagulopathy, and hemodynamic instability 2.
- Relative contraindications for PEG tube placement include peptic ulcer disease and hemodynamic or respiratory instability 2, 4.
- Contraindications for PEG-J and DPEJ include active peritonitis, uncorrectable coagulopathy, and ongoing bowel ischemia 3.
Comparison of PEG and PEG-J Tubes
- PEG tubes are associated with lower complication rates compared to jejunostomy tubes (J-tubes) 5.
- The most common causes for tube replacement in J-tube patients are dislodgement and obstruction, compared to routine replacement and dislodgement in the PEG tube group 5.
- The European Society of Gastrointestinal Endoscopy (ESGE) recommends the gastric route as the primary option in patients in need of enteral nutrition support, and the jejunal route should only be chosen in patients with altered or unfavorable gastric anatomy, impaired gastric emptying, intolerance to gastric feeding, or with a high risk of aspiration 4.