Percutaneous Gastrostomy and Jejunostomy

Percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic gastro-jejunal (PEG-J) tubes are common procedures in the management of patients who require long-term nutritional support. They serve as alternatives to enteral feeding and laparotomy-guided placement of feeding tubes. PEG tube placement was first introduced in 1980 and has a success rate of more than 95%. Patients typically require moderate sedation, and the estimated procedure-related mortality is 0.5%.  PEG and PEG-J tubes are important in patients with barriers to oral feeding, including benign or malignant conditions, iatrogenic causes such as radiation therapy that can lead to mechanical obstruction in the esophagus, motility disorders of the esophagus, neurologic causes resulting in oropharyngeal dysphagia, psychosomatic issues such as dementia, and mental retardation or developmental delay. In PEG tube placement, a tube is inserted directly into the stomach through the abdominal wall. In PEG-J tube placement, an extension is placed via the existing PEG tube into the jejunum to allow jejunal feeding. The latter is particularly useful in patients at high risk of aspiration from gastric feedings such as those with gastroparesis, gastric outlet obstruction, severe gastroesophageal reflux disease (GERD), gastric resection, history of repeated aspirations, or those who cannot tolerate gastric feeding. The placement of a PEG-J tube, however, has not been shown to prevent aspiration.