Percutaneous Endoscopic Gastrostomy and Jejunostomy for Feeding

Abstract

Percutaneous endoscopic feeding tube placement as suggested by its name is an endoscopy-guided artificially created ostomy connecting the gastric cavity and the skin surface. Enteral nutrition has been shown to be superior to parenteral nutrition in improving immunity and nutrition, but enteral access can be a challenge in patients who cannot swallow safely. The need for a percutaneous enteral access arises in patients who are expected to be dependent on tube feeds for a long time, usually for more than 1 month. The most common source of tube feeding is via a nasogastric (NG) or orogastric tube extending into the stomach or naso-jejunal (Dobhoff) tube which extends into the proximal small bowel. The tube is used for delivering tube feeds, water, and medications to the gut. The most common requirements for such a nutritional access are cancers involving upper airways, oral cavity, pharynx, or esophagus; dementia and cerebrovascular accidents with loss of ability to swallow. The procedures performed by gastroenterologists for enteral access include percutaneous endoscopic gastrostomy (PEG), percutaneous endoscopic gastrojejunostomy (PEGJ), and direct percutaneous endoscopic jejunostomy (DPEJ). The most commonly employed technique is the PEG.