Percutaneous Endoscopic Gastrostomy: Clinical Applications

John J. Vargo, MD, and Jeffrey L. Ponsky, MD, Cleveland Clinic Foundation, Cleveland, Ohio.

In This Article


Since its introduction in 1980, percutaneous endoscopic gastrostomy (PEG) has gained wide acceptance as the procedure of choice in delivering enteral alimentation and has largely replaced surgical gastrostomy. Refinements in the technique, including the "push" and "pull" methods, and the indications for this procedure have grown. Major complications resulting from PEG tube placement include peritonitis, hemorrhage, aspiration, peristomal wound infection, buried bumper syndrome, and gastrocolic fistula. Decompression, the second most common indication for PEG tube placement, is usually reserved for a select group of patients, such as those with diabetic gastroparesis; intestinal pseudo-obstruction; or mechanical obstruction due to malignancy, surgery, or other disease processes. Other applications of PEG include the treatment of gastric volvulus, the formation of a biliogastric shunt, pseudocyst drainage, delivery of pharmacotherapy, and the provision of an "avenue" for performing upper endoscopy. PEG may also play a role in the palliation of patients with AIDS and those with various neurologic and oncologic diseases. This article provides an overview of PEG technique and applications, including indications, contraindications, and the recognition and management of complications.


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