Skip to main content
SpringerLink
Log in

Enteral Access: Percutaneous Endoscopic Gastrostomy, Gastrostomy-Jejunostomy, and Jejunostomy

  • Chapter
  • First Online:
The SAGES Manual Operating Through the Endoscope

  • 469 Accesses

Abstract

Endoscopic approaches for enteral feeding access are the preferred method of long-term nutrition support. Compared to parenteral nutrition, enteral feeding provides physiological and structural benefits to the gastrointestinal tract, which in turn have systemic benefits. Additionally, endoscopic modalities are less invasive than surgical approaches, thereby reducing complication rates and duration of hospital stay. Percutaneous endoscopic gastrostomy was first introduced in 1980 and served as a cornerstone for the development of percutaneous endoscopic gastro-jejunostomy and percutaneous endoscopic jejunostomy. These procedures are commonly performed today for patients with various chronic, traumatic, or malignant conditions and who are in need of nutritional support. Although endoscopic enteral access provides many benefits, understanding its indications and limitations is critical for performing these procedures safely and effectively. This chapter provides an overview of current knowledge and practices in the rapidly evolving field of endoscopic enteral access, with emphasis on patient selection, preoperative considerations, technical conduct, and avoidance of complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

PEG:

Percutaneous endoscopic gastrostomy

PEG-J:

Percutaneous endoscopic gastrostomy-jejunostomy

PEJ:

Percutaneous endoscopic jejunostomy

References

  1. Ponsky JL, Gauderer MWL. Percutaneous endoscopic gastrostomy: a nonoperative technique for feeding gastrostomy. Gastrointest Endosc. 1981;27:9–11.

    Article  CAS  PubMed  Google Scholar 

  2. El-Matary W. Percutaneous endoscopic gastrostomy in children. Can J Gastroenterol. 2008;22:993–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Grant JP. Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy. Ann Surg. 1988;207:598–603.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, et al. The clinical course of advanced dementia. N Engl J Med. 2009;361:1529–38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Broadley S, Croser D, Cottrell J, Creevy M, Teo E, Yiu D, et al. Predictors of prolonged dysphagia following acute stroke. J Clin Neurosci. 2003;10:300–5.

    Article  CAS  PubMed  Google Scholar 

  6. FOOD Trial Collaboration. Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke. 2003;34:1450–6.

    Article  Google Scholar 

  7. Dennis MS, Lewis SC, Warlow C, FOOD Trial Collaboration. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet. 2005;365:764–72.

    Article  CAS  PubMed  Google Scholar 

  8. Dharmarajan T. Percutaneous endoscopic gastrostomy and outcome in dementia. Am J Gastroenterol. 2001;96:2556–63.

    Article  CAS  PubMed  Google Scholar 

  9. Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database Syst Rev. 2009;2009(2):CD007209. https://doi.org/10.1002/14651858.CD007209.pub2.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Akkersdijk WL, Roukema JA, van der Werken C. Percutaneous endoscopic gastrostomy for patients with severe cerebral injury. Injury. 1998;29:11–4.

    Article  CAS  PubMed  Google Scholar 

  11. Shepherd RW, Holt TL, Thomas BJ, Kay L, Isles A, Francis PJ, et al. Nutritional rehabilitation in cystic fibrosis: controlled studies of effects on nutritional growth retardation, body protein turnover, and course of pulmonary disease. J Pediatr. 1986;109:788–94.

    Article  CAS  PubMed  Google Scholar 

  12. Zhu Y, Shi L, Tang H, Tao G. Current considerations in direct percutaneous endoscopic jejunostomy. Can J Gastroenterol. 2012;26:92–6.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bender JS. Percutaneous endoscopic gastrostomy placement in the morbidly obese. Gastrointest Endosc. 1992;38:97–8.

    Article  CAS  PubMed  Google Scholar 

  14. Wiggins TF, Garrow DA, DeLegge MH. Evaluation of percutaneous endoscopic feeding tube placement in obese patients. Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. 2009;24:723–7.

    Google Scholar 

  15. Schrag SP, Sharma R, Jaik NP, Seamon MJ, Lukaszczyk JJ, Martin ND, et al. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointest Liver Dis JGLD. 2007;16:407–18.

    Google Scholar 

  16. Jafri NS, Mahid SS, Minor KS, Idstein SR, Hornung CA, Galandiuk S. Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy. Aliment Pharmacol Ther. 2007;25:647–56.

    Article  CAS  PubMed  Google Scholar 

  17. McCulloch A, Roy O, Massey D, Hedges R, Skerratt S, Wilson N, Woodward J. Nasal unsedated seated percutaneous endoscopic gastrostomy (nuPEG): a safe and effective technique for percutaneous endoscopic gastrostomy placement in high-risk candidates. Frontline Gastroenterol. 2018;9(2):105–9. https://doi.org/10.1136/flgastro-2017-100894. Epub 2017 Dec 5. PMID: 29588837; PMCID: PMC5868436

    Article  PubMed  Google Scholar 

  18. Kozarek RA, Ball TJ, Ryan JA. When push comes to shove: a comparison between two methods of percutaneous endoscopic gastrostomy. Am J Gastroenterol. 1986;81:642–6.

    CAS  PubMed  Google Scholar 

  19. Hogan RB, DeMarco DC, Hamilton JK, Walker CO, Polter DE. Percutaneous endoscopic gastrostomy—to push or pull. Gastrointest Endosc. 1986;32:253–8.

    Article  CAS  PubMed  Google Scholar 

  20. Foutch PG, Talbert GA, Waring JP, Sanowski RA. Percutaneous endoscopic gastrostomy in patients with prior abdominal surgery: virtues of the safe tract. Am J Gastroenterol. 1988;83:147–50.

    CAS  PubMed  Google Scholar 

  21. Jones DB, Mathiel SK, Schneider BE. Atlas of minimally invasive surgery. 1st ed. Woodbury, CT: Cine-Med, Inc; 2006. p. 276–97.

    Google Scholar 

  22. Kwon RS, Banerjee S, Desilets D, Diehl DL, Farraye FA, Kaul V, et al. Enteral nutrition access devices. Gastrointest Endosc. 2010;72:236–48.

    Article  PubMed  Google Scholar 

  23. Larson DE, Burton DD, Schroeder KW, Dimagno EP. Percutaneous endoscopic gastrostomy: indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology. 1987;93:48–52.

    Article  CAS  PubMed  Google Scholar 

  24. Taylor CA, Larson DE, Ballard DJ, Bergstrom LR, Silverstein MD, Zinsmeister AR, et al. Predictors of outcome after percutaneous endoscopic gastrostomy: a community-based study. Mayo Clin Proc. 1992;67:1042–9.

    Article  CAS  PubMed  Google Scholar 

  25. Loser C, Wolters S, Folsch UR. Enteral long-term nutrition via percutaneous endoscopic gastrostomy (PEG) in 210 patients a four-year prospective study. Dig Dis Sci. 1998;43:2549–57.

    Article  CAS  PubMed  Google Scholar 

  26. Kohli H, Bloch R. Percutaneous endoscopic gastrostomy: a community hospital experience. Am Surg. 1995;61:191–4.

    CAS  PubMed  Google Scholar 

  27. Davis JB Jr, Bowden TA Jr, Rives DA. Percutaneous endoscopic gastrostomy. Do surgeons and gastroenterologists get the same results? Am Surg. 1990;56:47–51.

    PubMed  Google Scholar 

  28. Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol. 2014;20:8505–24.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Longcroft-Wheaton G, Marden P, Colleypriest B, Gavin D, Taylor G, Farrant M. Understanding why patients die after gastrostomy tube insertion: a retrospective analysis of mortality. J Parenter Enter Nutr. 2009;33:375–9.

    Article  Google Scholar 

  30. DiSario JA, Baskin WN, Brown RD, DeLegge MH, Fang JC, Ginsberg GG, et al. Endoscopic approaches to enteral nutritional support. Gastrointest Endosc. 2002;55:901–8.

    Article  PubMed  Google Scholar 

  31. Rumalla A, Baron TH. Results of direct percutaneous endoscopic Jejunostomy, an alternative method for providing Jejunal feeding. Mayo Clin Proc. 2000;75:807–10.

    Article  CAS  PubMed  Google Scholar 

  32. Yamazaki T, Sakai Y, Hatakeyama K, Hoshiyama Y. Colocutaneous fistula after percutaneous endoscopic gastrostomy in a remnant stomach. Surg Endosc. 1999;13:280–2.

    Article  CAS  PubMed  Google Scholar 

  33. Patwardhan N, McHugh K, Drake D, Spitz L. Gastroenteric fistula complicating percutaneous endoscopic gastrostomy. J Pediatr Surg. 2004;39:561–4.

    Article  PubMed  Google Scholar 

  34. Kim HS, Lee DK, Baik SK, Kwon SO. Endoscopic management of Colocutaneous Fistula after percutaneous endoscopic gastrostomy. Endoscopy. 2002;34:430.

    Article  CAS  PubMed  Google Scholar 

  35. Currais P, Faias S, Francisco F, Sousa L, Gramacho J, Pereira AD. Gastrocutaneous fistulas after PEG removal in adult cancer patients: frequency and treatment options. Surg Endosc. 2021 May;35(5):2211–6. https://doi.org/10.1007/s00464-020-07627-z.

    Article  CAS  PubMed  Google Scholar 

  36. Morrell DJ, Winder JS, Johri A, Docimo S, Juza RM, Witte SR, Alli VV, Pauli EM. Over-the-scope clip management of non-acute, full-thickness gastrointestinal defects. Surg Endosc. 2020 Jun;34(6):2690–702. https://doi.org/10.1007/s00464-019-07030-3.

    Article  PubMed  Google Scholar 

  37. Sookpotarom P, Vejchapipat P, Chongsrisawat V, Mahayosnond A. Gastric volvulus caused by percutaneous endoscopic gastrostomy: a case report. J Pediatr Surg. 2005;40:e21–3.

    Article  PubMed  Google Scholar 

  38. Freeman C, Delegge MH. Small bowel endoscopic enteral access. Curr Opin Gastroenterol. 2009;25:155–9.

    Article  PubMed  Google Scholar 

  39. Potter MB, Bowers SB, Pruitt A. Internal hernia with small bowel volvulus in a patient with altered gut motility: a complication of direct percutaneous endoscopic jejunostomy. Dig Dis Sci. 2007;52:1910–3.

    Article  PubMed  Google Scholar 

  40. Sinclair J, Scolapio J, Stark M, Hinder R. Metastasis of head and neck carcinoma to the site of percutaneous endoscopic gastrostomy: case report and literature review. J Parenter Enter Nutr. 2001;25:282–5.

    Article  CAS  Google Scholar 

  41. James A, Kapur K, Hawthorne AB. Long-term outcome of percutaneous endoscopic gastrostomy feeding in patients with dysphagic stroke. Age Ageing. 1998;27:671–6.

    Article  CAS  PubMed  Google Scholar 

  42. Grant JP. Percutaneous endoscopic gastrostomy. Initial placement by single endoscopic technique and long-term follow-up. Ann Surg. 1993;217:168–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Kadakia SC, Sullivan HO, Starnes E. Percutaneous endoscopic gastrostomy or jejunostomy and the incidence of aspiration in 79 patients. Am J Surg. 1992;164:114–8.

    Article  CAS  PubMed  Google Scholar 

  44. Greif JM, Ragland JJ, Gage Ochsner M, Riding R. Fatal necrotizing fasciitis complicating percutaneous endoscopic gastrostomy. Gastrointest Endosc. 1986;32:292–4.

    Article  CAS  PubMed  Google Scholar 

  45. Cave DR, Robinson WR, Brotschi EA. Necrotizing fasciitis following percutaneous endoscopic gastrostomy. Gastrointest Endosc. 1986;32:294–6.

    Article  CAS  PubMed  Google Scholar 

  46. Chung RS, Schertzer M. Pathogenesis of complications of percutaneous endoscopic gastrostomy. A lesson in surgical principles. Am Surg. 1990;56:134–7.

    CAS  PubMed  Google Scholar 

  47. Safadi BY, Marks JM, Ponsky JL. Percutaneous endoscopic gastrostomy. Gastrointest Endosc Clin N Am. 1998;8:551–68.

    Article  CAS  PubMed  Google Scholar 

  48. Lipp A, Lusardi G. Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy. Cochrane Database Syst Rev. 2013;11:CD005571.

    Google Scholar 

  49. Gurusamy KS, Koti R, Wilson P, Davidson BR. Antibiotic prophylaxis for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) related complications in surgical patients. Cochrane Database Syst Rev. 2013;19(8):CD010268. https://doi.org/10.1002/14651858.CD010268.pub2.

    Article  Google Scholar 

  50. Anderson MA, Ben-Menachem T, Gan SI, Appalaneni V, Banerjee S, Cash BD, et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc. 2009;70:1060–70.

    Article  PubMed  Google Scholar 

  51. Kanie J, Akatsu H, Suzuki Y, Shimokata H, Iguchi A. Mechanism of the development of gastric ulcer after percutaneous endoscopic gastrostomy. Endoscopy. 2002;34:480–3.

    Article  CAS  PubMed  Google Scholar 

  52. Odom SR, Barone JE, Docimo S, Bull SM, Jorgensson D. Emergency department visits by demented patients with malfunctioning feeding tubes. Surg Endosc. 2003 Apr;17(4):651–3. https://doi.org/10.1007/s00464-002-8599-y.

    Article  CAS  PubMed  Google Scholar 

  53. Dwyer KM, Watts DD, Thurber JS, Benoit RS, Fakhry SM. Percutaneous endoscopic gastrostomy: the preferred method of elective feeding tube placement in trauma patients. J Trauma. 2002;52:26–32.

    PubMed  Google Scholar 

  54. Wiesen AJ, Sideridis K, Fernandes A, Hines J, Indaram A, Weinstein L, et al. True incidence and clinical significance of pneumoperitoneum after PEG placement: a prospective study. Gastrointest Endosc. 2006;64:886–9.

    Article  PubMed  Google Scholar 

  55. Nazarian A, Cross W, Kowdley GC. Pneumoperitoneum after percutaneous endoscopic gastrostomy among adults in the intensive care unit: incidence, predictive factors, and clinical significance. Am Surg. 2012;78:591–4.

    Article  PubMed  Google Scholar 

  56. Wojtowycz M, Arata J, Micklos T, Miller F. CT findings after uncomplicated percutaneous gastrostomy. Am J Roentgenol. 1988;151:307–9.

    Article  CAS  Google Scholar 

  57. Friginal-Ruiz A, Lucendo A, PhD MD. Percutaneous endoscopic gastrostomy: a practical overview on its indications, placement conditions, management, and nursing care. Gastroenterol Nurs. 2015;38(5):354–66. https://doi.org/10.1097/SGA.0000000000000150.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Valley Health System General Surgery Residency Program, Las Vegas, NV, USA

    Kelli Ifuku & Shawn Tsuda

Authors
  1. Kelli Ifuku
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shawn Tsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shawn Tsuda .

Editor information

Editors and Affiliations

  1. Digestive Disease Inst, A100, Cleveland Clinic, Cleveland, OH, USA

    Matthew Kroh

  2. Department of Surgery, University of South Florida, Tampa, FL, USA

    Salvatore Docimo Jr.

  3. BariJuve Surgical, Hoffman Estates, IL, USA

    Sofiane El Djouzi

  4. Department of Surgery, University of Wisconsin Health, Madison, WI, USA

    Amber Shada

  5. Center for Advanced Surgery, The Oregon Clinic, Portland, OR, USA

    Kevin M. Reavis

Rights and permissions

Reprints and permissions

Copyright information

© 2023 SAGES

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ifuku, K., Tsuda, S. (2023). Enteral Access: Percutaneous Endoscopic Gastrostomy, Gastrostomy-Jejunostomy, and Jejunostomy. In: Kroh, M., Docimo Jr., S., El Djouzi, S., Shada, A., Reavis, K.M. (eds) The SAGES Manual Operating Through the Endoscope. Springer, Cham. https://doi.org/10.1007/978-3-031-21044-0_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-21044-0_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-21043-3

  • Online ISBN: 978-3-031-21044-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation