What is the role of percutaneous endoscopic gastrostomy in the treatment of dysphagia?

Updated: Mar 20, 2020
  • Author: Nam-Jong Paik, MD, PhD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Percutaneous endoscopic gastrostomy (PEG), in which endoscopy is used to percutaneously place a tube into the stomach, has several advantages over surgical gastrostomy (which requires a laparotomy under general or local anesthesia). These include reduced procedure time, cost, and recovery time, as well as the fact that PEG requires no general anesthesia. However, PEG does require the invasive insertion of the feeding tube through the anterior abdominal wall, which can result in complications, including the following [64] :

  • Bleeding

  • Peritonitis or perforation of other abdominal organs

  • Chest infections

  • Local infection around the insertion site

  • The tubes being pulled out

Relative contraindications for PEG are aspiration pneumonia due to gastroesophageal reflux, significant ascites, and morbid obesity. Prospective, randomized trials have shown increased compliance, convenience, and continuity of feeding with PEG tubes compared with nasogastric intubation.

Reflux prevention involves feeding the patient in a vertical position, using H2 blockers to decrease gastric pH, chlorpromazine or Maxolon to facilitate gastric emptying, and proton-pump inhibitors to decrease gastroesophageal reflux.

In one meta-analysis comparing effectiveness and safety between NGT feeding and PEG, PEG was found to be safer and more effective than NGT use. Intervention failure occurred in 19 of 156 patients in the PEG group, compared with 63 of 158 patients in the NGT group. However, complications, mortality rates, and pneumonia rates were comparable between NGT feeding and PEG. [65]


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