Percutaneous Gastrostomy: A Guide to the Procedure - Radiology

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Percutaneous gastrostomy (PEG) is a minimally invasive procedure that allows for the placement of a feeding tube directly into the stomach through the abdominal wall. This technique has evolved significantly over the years, transitioning from traditional surgical methods to more advanced endoscopic and fluoroscopic guidance, which enhances patient safety and reduces recovery time.


Overview of the Procedure
1. Indications for PEG: PEG is typically indicated for patients who are unable to eat by mouth due to various medical conditions, such as neurological disorders (e.g., stroke, ALS), head and neck cancers, or severe swallowing difficulties (dysphagia). It is also used in patients requiring long-term nutritional support.

2. Pre-Procedure Preparation: Before the procedure, patients are usually required to fast for at least 12 hours. They may receive intravenous sedation and analgesia to ensure comfort during the procedure. A nasogastric tube may be placed temporarily to help inflate the stomach with air, making it easier to visualize during the procedure.

3. Procedure Techniques:
- Percutaneous Endoscopic Gastrostomy (PEG): This technique utilizes an endoscope to guide the placement of the feeding tube. The endoscope allows the physician to visualize the stomach and the abdominal wall, ensuring accurate placement of the tube. The stomach is inflated with air to bring it closer to the abdominal wall, and a needle is inserted through the skin into the stomach under direct visualization. A guide wire is then threaded through the needle, and the feeding tube is placed over the wire.

- Percutaneous Fluoroscopic Gastrostomy (PFG): In this method, fluoroscopy (real-time X-ray imaging) is used to guide the placement of the feeding tube. Similar to PEG, the stomach is inflated, and the physician uses fluoroscopic imaging to locate the appropriate site for puncture and tube insertion.

4. Duration and Recovery: The entire procedure typically takes about 30 minutes. Patients are often able to return home the same day if there are no complications. After the procedure, feeding can usually begin within 24 hours, depending on the physician's assessment.


Post-Procedure Care
After a PEG tube is placed, patients require careful monitoring and care to prevent complications. Common post-procedure considerations include:
- Site Care: The insertion site should be kept clean and dry. Regular cleaning with saline or soap and water is recommended to prevent infection.

- Feeding Protocol: Patients may start with clear liquids and gradually progress to a full feeding regimen as tolerated. It's essential to follow the dietary recommendations provided by a nutritionist or healthcare provider.

- Monitoring for Complications: Patients should be monitored for signs of infection (redness, swelling, discharge at the site), tube dislodgment, or leakage around the tube. If any of these occur, prompt medical attention is necessary.


Potential Complications
While PEG is generally safe, there are potential risks and complications, including:
- Infection: As with any procedure that involves puncturing the skin, there is a risk of infection at the insertion site.

- Bleeding: Minor bleeding may occur, but significant bleeding is rare.

- Peritonitis: If the stomach is punctured incorrectly, there is a risk of peritonitis, which is an infection of the abdominal cavity.

- Tube Dislodgment: The feeding tube can become dislodged, requiring replacement.


Conclusion
Percutaneous gastrostomy is a valuable procedure for patients requiring long-term nutritional support. With advancements in technique and technology, PEG has become a safer and more efficient option compared to traditional surgical methods. Patients and caregivers should be well-informed about the procedure, post-care requirements, and potential complications to ensure optimal outcomes. Always consult with a healthcare provider for personalized advice and recommendations based on individual health needs.