From the Guidelines
Percutaneous endoscopic gastrostomy (PEG) tubes are typically placed by gastroenterologists, who most commonly perform this procedure using an endoscope to visualize the stomach from inside while creating the opening through the abdominal wall 1.
Specialist Options
The choice of specialist often depends on the patient's specific medical condition, local hospital resources, and the expertise available.
- Gastroenterologists are the primary specialists for PEG tube placement, using endoscopy to guide the procedure.
- Interventional radiologists may place tubes using imaging guidance (fluoroscopy) in a technique called percutaneous radiologic gastrostomy (PRG).
- Surgeons can place feeding tubes either laparoscopically or during open abdominal surgery.
Procedure Considerations
For instance, patients with head and neck cancers or neurological conditions that make endoscopy difficult might be referred to interventional radiology, while those already undergoing abdominal surgery might have a tube placed by a surgeon.
- The procedure typically takes 15-30 minutes when performed endoscopically and requires moderate sedation rather than general anesthesia in most cases, making it a relatively low-risk option for providing long-term enteral nutrition access 1.
- According to the ESPEN guidelines, PEG placement using the standard pull-through method takes approximately 12 minutes 1.
Decision Making
The decision to place a PEG tube should be based on the patient's nutritional needs and the expected duration of enteral nutrition, with PEG feeding preferred if it can be expected that the patient’s nutritional intake is likely to be inadequate and supplementary artificial enteral nutrition is necessary for a period exceeding 2–3 weeks 1.
- Figure 1 from the ESPEN guidelines provides a decision tree for selecting the tube system for enteral nutrition most appropriate to the requirements of the individual case 1.
From the Research
Specialist Places for PEG Tubes
- PEG tubes are placed by gastroenterologists (GI) and surgeons throughout the country 2.
- Acute care surgeons (ACS) also perform PEGs at the bedside in ICUs 2.
- Interventional pulmonologists can also place PEG tubes in the ICU 3.
- Radiologists can perform fluoroscopy-guided gastrostomy (IR-gastrostomy) 4.
- Surgeons can perform open gastrostomy (surgical gastrostomy) 4.
Comparison of PEG Tube Placement by Different Specialists
- There was no significant difference in success rates between surgery and GI in placing PEGs 2.
- GI performed the procedure faster than surgery 2.
- No significant differences were found in PEG outcomes or complications between PEGs placed by ACS or GI 2.
- Endoscopic gastrostomy tube placement (PEG) is associated with a significantly lower risk of inpatient adverse events, mortality, and readmission rates compared with IR-gastrostomy and open surgical gastrostomy 4.