Clinical Endoscopy

Review

Clinical practice guidelines for percutaneous endoscopic gastrostomy: Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee, Korean Society of Gastrointestinal Endoscopy Task Force on Clinical Practice Guidelines; Clin Endosc 2023;56(4):391-408. Published online June 23, 2023; DOI: https://doi.org/10.5946/ce.2023.062

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With an aging population, the number of patients with difficulty in swallowing due to medical conditions is gradually increasing. In such cases, enteral nutrition is administered through a temporary nasogastric tube. However, the long-term use of a nasogastric tube leads to various complications and a decreased quality of life. Percutaneous endoscopic gastrostomy (PEG) is the percutaneous placement of a tube into the stomach that is aided endoscopically and may be an alternative to a nasogastric tube when enteral nutritional is required for four weeks or more. This paper is the first Korean clinical guideline for PEG developed jointly by the Korean College of Helicobacter and Upper Gastrointestinal Research and led by the Korean Society of Gastrointestinal Endoscopy. These guidelines aimed to provide physicians, including endoscopists, with the indications, use of prophylactic antibiotics, timing of enteric nutrition, tube placement methods, complications, replacement, and tube removal for PEG based on the currently available clinical evidence.

Citations

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A Multicenter Survey of Percutaneous Endoscopic Gastrostomy in 2019 at Korean Medical Institutions
Jun Woo Park, Tae Gyun Kim, Kwang Bum Cho, Jeong Seok Kim, Jin Woong Cho, Jung Won Jeon, Sun Gyo Lim, Chan Gyoo Kim, Hong Jun Park, Tae Jun Kim, Eun Sun Kim, Su Jin Jeong, Yong Hwan Kwon
Gut and Liver.2024; 18(1): 77. CrossRef
Fast-track discharge following percutaneous endoscopic gastrostomy removal in head and neck cancer patients after remission: a feasibility and safety study
Daniel Conceição, Luís Correia Gomes, Fátima Francisco, Ivone Frade, Joana Gramacho, Sandra Faias, Isabel Claro
Journal of Gastrointestinal Surgery.2024; 28(6): 943. CrossRef
When to feed after percutaneous endoscopic gastrostomy: A systematic review and meta‐analysis of randomized controlled trials
Matthew L. Bechtold, Zahid Ijaz Tarar, Muhammad N. Yousaf, Ghady Moafa, Abdul M. Majzoub, Xheni Deda, Michelle L. Matteson‐Kome, Srinivas R. Puli
Nutrition in Clinical Practice.2024; 39(5): 1191. CrossRef
The Effect of Oral Diet Training in Indwelling Nasogastric Tube Patients with Prolonged Dysphagia
Byung-chan Choi, Sook Joung Lee, Eunseok Choi, Sangjee Lee, Jungsoo Lee
Nutrients.2024; 16(15): 2424. CrossRef
The Impact of Palliative Decompressive Gastrostomy Tube Placement on Patients and Their Caregivers: A Mixed Methods Analysis
Jeffrey L. Roberson, Julia A. Gasior, Sara P. Ginzberg, Emna Bakillah, Jesse Passman, Lauren Shreve, Catherine E. Sharoky, Gregory Nadolski, Katherine R. Courtright, Elinore J. Kaufman
Annals of Surgical Oncology.2024;[Epub] CrossRef
A systematic review and quality appraisal of guidelines and recommendations for home enteral tube feeding in adults
Andriana Korai, Isabella Thomson, Sharon Carey, Margaret Allman-Farinelli
European Journal of Clinical Nutrition.2024;[Epub] CrossRef

4,847 View
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Case Report

Endoscopic hemostasis using an over-the-scope clip for massive bleeding after percutaneous endoscopic gastrostomy removal: a case report: Sun Young Moon, Min Kyu Jung, Jun Heo; Clin Endosc 2022;55(3):443-446. Published online May 25, 2021; DOI: https://doi.org/10.5946/ce.2020.294

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Percutaneous endoscopic gastrostomy (PEG) is a common method for providing long-term enteral nutrition to patients. PEG tube placement and removal are relatively safe; generally, a PEG tube can be removed using gentle traction, and excessive bleeding is rare. The over-the-scope clip system is a new device that can be used for gastrointestinal hemostasis and for closing gastrointestinal fistulae. In the present case, a 68-year-old male patient had to remove the PEG tube because of persistent leakage around the PEG tube. Although it was gently removed using traction, incessant bleeding continued, with a Rockall score of 5 points, even after hemocoagulation was attempted. An over-the-scope clip device was used to achieve hemostasis and fistula closure.

Citations

Citations to this article as recorded by

Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Gut and Liver.2024; 18(1): 10. CrossRef
Clinical practice guidelines for percutaneous endoscopic gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Clinical Endoscopy.2023; 56(4): 391. CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
The Korean Journal of Gastroenterology.2023; 82(3): 107. CrossRef

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Original Articles

Infant Percutaneous Endoscopic Gastrostomy: Risks or Benefits?: Francesco Macchini, Andrea Zanini, Giorgio Farris, Anna Morandi, Giulia Brisighelli, Valerio Gentilino, Giorgio Fava, Ernesto Leva; Clin Endosc 2018;51(3):260-265. Published online January 9, 2018; DOI: https://doi.org/10.5946/ce.2017.137

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Background
/Aims: To present a single center’s experience with percutaneous endoscopic gastrostomy (PEG) tube placement in infants.
Methods
Clinical records of infants who underwent PEG tube placement between January 2010 and December 2015 were reviewed. All patients underwent an upper gastrointestinal contrast study and an abdominal ultrasonography before the procedure. PEGs were performed with a 6-mm endoscope using the standard pull-through technique. Data regarding gestational age, birth weight, age and weight, days to feeding start, days to full diet, and complications were reviewed.
Results
Twenty-three patients were included. The most common indication was dysphagia related to hypoxic-ischemic encephalopathy. Median gestational age was 37 weeks (range, 24–41) and median birth weight was 2,605 grams (560–4,460). Patients underwent PEG procedures at a median age of 114 days (48–350); mean weight was 5.1 kg (3.2–8.8). In all patients but one, a 12-Fr tube was positioned. Median feeding start was 3 days (1–5) and on average full diet was achieved 5 days after the procedure (2–11). Six minor complications were recorded and effectively treated in the outpatient clinic; no major complications were recorded.
Conclusions
PEG is safe and feasible in infants when performed by highly experienced physicians.

Citations

Citations to this article as recorded by

Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Gut and Liver.2024; 18(1): 10. CrossRef
Clinical practice guidelines for percutaneous endoscopic gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Clinical Endoscopy.2023; 56(4): 391. CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
The Korean Journal of Gastroenterology.2023; 82(3): 107. CrossRef
Single-Incision Open versus Laparoscopic Gastrostomy in Infants: A Comparative Study
Osama A. Bawazir, Ahmed Hasan Alamoudi
African Journal of Paediatric Surgery.2023; 20(4): 274. CrossRef
Comparison of general endotracheal anesthesia versus sedation without endotracheal intubation during initial percutaneous endoscopic gastrostomy insertion for infants: A retrospective cohort study
Jacquelin Peck, Jerry Brown, Jamie L. Fierstein, Anh Thy H. Nguyen, Ernest K. Amankwah, Mohamed Rehman, Michael Wilsey
Pediatric Anesthesia.2022; 32(12): 1310. CrossRef
Laparoscopic Repair of a Gastrocolocutaneous Fistula: Percutaneous Endoscopic Gastrostomy Placement Complications in Children
Riccardo Guanà, Salvatore Garofalo, Luca Lonati, Elisabetta Teruzzi, Fabio Cisarò, Fabrizio Gennari
Journal of Laparoendoscopic & Advanced Surgical Techniques.2020; 30(2): 216. CrossRef
Congenital Zika Syndrome
Ann Gaba, Ghada A. Soliman
Topics in Clinical Nutrition.2020; 35(2): 154. CrossRef
Enteral Feeding
Colin G. DeLong, Eric M. Pauli
Advances in Surgery.2020; 54: 231. CrossRef
Non-vascular interventional radiology in the paediatric alimentary tract
Premal A. Patel, Kishore Minhas, Jestine Ang, Sam Stuart, Paolo De Coppi, Ralph Gnannt
European Journal of Radiology.2019; 112: 72. CrossRef
A comparison of laparoscopic gastrostomy tubes and percutaneous endoscopic gastrostomy in infants: results from a single institution
Shefali Thaker, Meghna V. Misra
Journal of Pediatric Surgery.2019; 54(11): 2453. CrossRef

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10 Crossref

Safety of Percutaneous Endoscopic Gastrostomy Tubes in Centenarian Patients: Zain A Sobani, Kevin Tin, Steven Guttmann, Anna A Abbasi, Ira Mayer, Yuriy Tsirlin; Clin Endosc 2018;51(1):56-60. Published online July 21, 2017; DOI: https://doi.org/10.5946/ce.2017.059

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Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure; however, no study has evaluated the safety of PEG tube placement in patients over the age of 100 years.
Methods
We conducted a retrospective review of patient records for patients who underwent PEG tube placement. Thirty patients aged 100 years and older were identified and a random sample of 275 patients was selected for comparison.
Results
The mean age of the patients was 80.6±16.2 years. No procedure-related deaths or major complications were identified; the overall inpatient mortality rate was 7.6%. Minor complications were noted in 4% (n=12) of the patients. Centenarian patients were predominantly female (80% [n=24] vs. 54% [n=147], p=0.006), with a mean age of 100.5±0.9 years. There was no significant difference in procedural success rates (93.3% vs. 97.4%, p=0.222) or inpatient mortality (6.7% [n=2] vs. 7.7% [n=21], p=1.000) between the two groups. However, a higher minor complication rate was noted in the older patients (13.3% [n=4] vs. 2.9% [n=8], p=0.022).
Conclusions
Success rates, major complications and inpatient mortality associated with PEG tubes in patients aged over 100 years are comparable to those observed in relatively younger patients at our center; however minor complication rates are relatively higher. These findings lead us to believe that PEG tubes may be safely attempted in carefully selected patients in this subset of the population.

Citations

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In-hospital, 30- and 90-day mortality in elderly trauma patients with operative feeding tubes
Derek R. Marlor, Khaled M. Taghlabi, Anneliese N. Hierl, Maxwell C. Braasch, Robert D. Winfield
The American Journal of Surgery.2023; 225(4): 758. CrossRef
Comparison Between Geriatric and Non-geriatric Patients in the Development of Complications After Percutaneous Endoscopic Gastrostomy
Cem Azılı, Harun Karabacak, Şener Balas, Muhammed Apaydın, Selim Tamam, Serdar Çulcu, Ahmet Oğuz Hasdemir
European Journal of Geriatrics and Gerontology.2023; 5(2): 144. CrossRef
Long‐term prognosis of enteral feeding and parenteral nutrition in a population aged 75 years and older: a population‐based cohort study
Yukio Tsugihashi, Manabu Akahane, Yasuhiro Nakanishi, Tomoya Myojin, Shinichiro Kubo, Yuichi Nishioka, Tatsuya Noda, Shuichiro Hayashi, Shiori Furihata, Tsuneyuki Higashino, Tomoaki Imamura
BMC Geriatrics.2021;[Epub] CrossRef
Percutaneous Transesophageal Gastro‐Tubing as an Alternative Procedure of Levodopa Administration in Parkinson's Disease
Noriyuki Miyaue, Hayato Yabe, Masahiro Nagai, Masahiro Nomoto
Movement Disorders Clinical Practice.2020; 7(6): 730. CrossRef
Analyzing functional status and its correlates in Chinese centenarians: A cross‐sectional study
Zhaoyong Huang, Yuzhu Chen, Weiwen Zhou, Xiaopeng Li, Qiulan Qin, Yunqing Fei, Xinqi Dong, Fang Yu
Nursing & Health Sciences.2020; 22(3): 639. CrossRef
Percutaneous endoscopic gastrostomy for enteral nutrition: a 5-year clinical experience with 324 patients
Ezekiel W. Toh Yoon, Kaori Yoneda, Kazuki Nishihara
Minerva Gastroenterologica e Dietologica.2019;[Epub] CrossRef
RISK FACTORS ASSOCIATED WITH EARLY MORTALITY AFTER PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN PATIENTS AT A TERTIARY CARE CENTER IN BRAZIL: A RETROSPECTIVE SINGLE-CENTER SURVIVAL STUDY
Luiz Eduardo MIRANDA, Marcel Rolland Ciro da PENHA, Ana Clara Galindo MIRANDA, Diego Laurentino LIMA, Matheus Wanderly Fernandes COSTA, Alexandre de Oliveira AMORIM
Arquivos de Gastroenterologia.2019; 56(4): 412. CrossRef
Is Percutaneous Endoscopic Gastrostomy Acceptable in Centenarian Patients?
Cheol Min Shin, Dong Ho Lee
Clinical Endoscopy.2018; 51(1): 1. CrossRef

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Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population: Abhinav Goyal, Kshitij Chatterjee, Sujani Yadlapati, Shailender Singh; Clin Endosc 2017;50(4):366-371. Published online March 17, 2017; DOI: https://doi.org/10.5946/ce.2016.155

Abstract PDF PubReader ePub

Background
/Aims: Esophageal stricture is usually managed with outpatient endoscopic dilation. However, patients with food impaction or failure to thrive undergo inpatient dilation. Esophageal perforation is the most feared complication, and its risk in inpatient setting is unknown.
Methods
We used National Inpatient Sample (NIS) database for 2007–2013. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes were used to identify patients with esophageal strictures. Logistic regression was used to assess association between hospital/patient characteristics and utilization of esophageal dilation.
Results
There were 591,187 hospitalizations involving esophageal stricture; 4.2% were malignant. Endoscopic dilation was performed in 28.7% cases. Dilation was more frequently utilized (odds ratio [OR], 1.36; p<0.001), had higher in-hospital mortality (3.1% vs. 1.4%, p<0.001), and resulted in longer hospital stays (5 days vs. 4 days, p=0.01), among cases of malignant strictures. Esophageal perforation was more common in the malignant group (0.9% vs. 0.5%, p=0.007). Patients with malignant compared to benign strictures undergoing dilation were more likely to require percutaneous endoscopic gastrostomy or jejunostomy (PEG/J) tube (14.1% vs. 4.5%, p<0.001). Palliative care services were utilized more frequently in malignant stricture cases not treated with dilation compared to those that were dilated.
Conclusions
Inpatient endoscopic dilation was utilized in 29% cases of esophageal stricture. Esophageal perforation, although infrequent, is more common in malignant strictures.

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Safe and Proper Management of Esophageal Stricture Using Endoscopic Esophageal Dilation
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Percutaneous Endoscopic Gastrostomy Tube Insertion in Neurodegenerative Disease: A Retrospective Study and Literature Review: Pamela Sarkar, Alice Cole, Neil J. Scolding, Claire M. Rice; Clin Endosc 2017;50(3):270-278. Published online October 13, 2016; DOI: https://doi.org/10.5946/ce.2016.106

Abstract PDF PubReader ePub

Background
/Aims: With the notable exceptions of dementia, stroke, and motor neuron disease, relatively little is known about the safety and utility of percutaneous endoscopic gastrostomy (PEG) tube insertion in patients with neurodegenerative disease. We aimed to determine the safety and utility of PEG feeding in the context of neurodegenerative disease and to complete a literature review in order to identify whether particular factors need to be considered to improve safety and outcome.
Methods
A retrospective case note review of patients referred for PEG insertion by neurologists in a single neuroscience center was conducted according to a pre-determined set of standards. For the literature review, we identified references from searches of PubMed, mainly with the search items “percutaneous endoscopic gastrostomy” and “neurology” or “neurodegenerative disease.”
Results
Short-term mortality and morbidity associated with PEG in patients with neurological disease were significant. Age greater than 75 years was associated with poor outcome, and a trend toward adverse outcome was observed in patients with low serum albumin.
Conclusions
This study highlights the relatively high risk of PEG in patients with neurodegenerative disease. We present points for consideration to improve outcome in this particularly vulnerable group of patients.

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Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Gut and Liver.2024; 18(1): 10. CrossRef
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Christopher Kobylecki, Yee Yen Goh, Rahema Mohammad, Alanna Beat, Emilia Michou, Samantha Pavey, Huw Morris, Henry Houlden, Viorica Chelban
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Clinical Endoscopy.2023; 56(4): 391. CrossRef
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Sean Lee, Abheek Ghosh, Aislynn Raymond, Nabeel M. Akhter
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Parkinsonism & Related Disorders.2017; 43: 110. CrossRef
Indication and Clinical Outcomes of Percutaneous Endoscopic Gastrostomy: A Single-center Retrospective Analysis
Ju Sung Sim, Seoung Young Kim, Ye Jin Lee, Ji Hye Seo, Dong Ju Kim, Jung Wan Choe, Dongwon Lee, Sung Woo Jung, Sang Woo Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2017; 17(3): 138. CrossRef
Palliativmedizin bei Patienten mit Parkinson-Erkrankungen
Christiane Weck, Stefan Lorenzl
DNP - Der Neurologe & Psychiater.2017; 18(7-8): 36. CrossRef

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Case Reports

Utility of Over-the-Scope Clipping for Closure of a Persistent Post-Percutaneous Endoscopic Gastrostomy Fistula under Long-Term Steroid Therapy: Yoshihisa Arao, Yuichi Sato, Satoru Hashimoto, Hiroki Honda, Kazumi Yoko, Masaaki Takamura, Ken-ichi Mizuno, Masaaki Kobayashi; Clin Endosc 2015;48(6):563-565. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.563

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A 50-year-old woman had a percutaneous endoscopic gastrostomy (PEG) tube placed after surgery for pharyngeal cancer. After 21 months, the PEG tube was removed due to improvement of per-oral ingestion. She had taken prednisolone for 31 years for systemic lupus erythematosus. The post-PEG fistula did not close spontaneously. The cause of the fistula was slow wound healing and gastrostomy site inflammation due to long-term steroid therapy. We were able to close the fistula with an over-the-scope clipping (OTSC) system. This case suggests that OTSC is useful for closing persistent post-PEG fistulas in patients receiving long-term prednisolone therapy.

Citations

Citations to this article as recorded by

UEG Week 2016 Poster Presentations

United European Gastroenterology Journal.2016; 4(5_suppl): A157. CrossRef

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Percutaneous Endoscopic Gastrostomy Through the Sinus Tract of a Surgical Gastrostomy: Katerina Kotzampassi, George Stavrou; Clin Endosc 2015;48(1):78-80. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.78

Abstract PDF PubReader ePub

We present the case of a woman on whom a percutaneous endoscopic gastrostomy (PEG) was performed through the sinus tract of a previous surgical gastrostomy for supraglottic obstructing malignancy. Five years after the induction of the surgical gastrostomy, she experienced a peristomal leakage, leading to severe necrotizing fasciitis, with skin irritation and inflammation. Despite extensive treatment to heal the abdominal wall close to the feeding tube, it recurred 3 months later, without any obvious cause. It was thus decided to perform a new gastrostomy in a nearby normal skin area, but, since it was totally impossible for the endoscope to be passed by mouth, due to obstruction, the sinus tract of the gastrostomy was used to facilitate endoscope insertion into the stomach for a new PEG.

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Percutaneous endoscopic gastrostomy through a cervical esophageal fistula. An alternative, much improved technique for patient safety
George Stavrou, Vassilios Grosomanidis, Anastasia Sarafidou, Gavriil Tsiropoulos, Stefanos Triaridis, Katerina Kotzampassi
American Journal of Otolaryngology.2020; 41(3): 102408. CrossRef

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1 Web of Science
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Original Article

Comparison of Clinical Outcomes Associated with Pull-Type and Introducer-Type Percutaneous Endoscopic Gastrostomies: Sin Won Lee, Jeong Hoon Lee, Hyungjin Cho, Yeonjung Ha, Hyun Lim, Ji Yong Ahn, Kwi Sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Jin-Ho Kim; Clin Endosc 2014;47(6):530-537. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.530

Abstract PDF PubReader ePub

Background/Aims

Percutaneous endoscopic gastrostomy (PEG) is a method of providing enteral nutrition using endoscopy. The PEG techniques differ according to the insertion method, and include the pull type, push type, and introducer type. The aim of this study was to compare the clinical outcomes associated with the pull-type and introducer-type PEG insertion techniques, which included the adverse events, at our tertiary care center in Korea.

Methods

We retrospectively reviewed 141 cases that had undergone PEG insertion at our center from January 2009 to June 2012. The indications for PEG insertion and the acute and chronic complications caused by each type of PEG insertion were analyzed.

Results

The indications for PEG insertion in our cohort included neurologic disease (58.7%), malignancy (21.7%), and other indications (19.6%). Successful PEG insertions were performed on 136 cases (96.5%), and there were no PEG-associated deaths. Bleeding was the most frequent acute complication (12.8%), and wound problems were the most frequent chronic complications (8.8%). There were no statistically significant differences between the pull-type and introducer-type PEG insertion techniques in relation to complication rates in our study population.

Conclusions

PEG insertion is considered a safe procedure. The pull-type and introducer-type PEG insertion techniques produce comparable outcomes, and physicians may choose either of these approaches according to the circumstances.

Citations

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Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Gut and Liver.2024; 18(1): 10. CrossRef
Clinical practice guidelines for percutaneous endoscopic gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
Clinical Endoscopy.2023; 56(4): 391. CrossRef
Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy
Chung Hyun Tae, Ju Yup Lee, Moon Kyung Joo, Chan Hyuk Park, Eun Jeong Gong, Cheol Min Shin, Hyun Lim, Hyuk Soon Choi, Miyoung Choi, Sang Hoon Kim, Chul-Hyun Lim, Jeong-Sik Byeon, Ki-Nam Shim, Geun Am Song, Moon Sung Lee, Jong-Jae Park, Oh Young Lee
The Korean Journal of Gastroenterology.2023; 82(3): 107. CrossRef
Buried T-Bar after Gastrostomy Placement in Children
Soon Chul Kim
Indian Journal of Pediatrics.2022; 89(8): 833. CrossRef
Nationwide Survey for Pediatric Gastrostomy Tube Placement in Korea
Sangwoo Lee, Byung-Ho Choe, Ben Kang, Soon Chul Kim
Journal of Korean Medical Science.2022;[Epub] CrossRef
Clinical Outcomes of Enteral Feeding Protocol Via Percutaneous Endoscopic Gastrostomy: A Single‐Center, Retrospective Study
Jin Hee Noh, Hee Kyong Na, Ji Yong Ahn, Suk‐Kyung Hong, Jiyoun Kim, Jina Yang, Hwoon‐Yong Jung
Nutrition in Clinical Practice.2021; 36(1): 225. CrossRef
Relationship of early acute complications and insertion site in push method percutaneous endoscopic gastrostomy
Hiroshi Suzuki, Satoru Joshita, Tadanobu Nagaya, Koichi Sato, Akihiro Ito, Tomoaki Suga, Takeji Umemura
Scientific Reports.2020;[Epub] CrossRef
The efficacy of a novel percutaneous endoscopic gastrostomy simulator using three‐dimensional printing technologies
Hee Kyong Na, Ji Yong Ahn, Gin Hyug Lee, Jeong Hoon Lee, Do Hoon Kim, Kee Wook Jung, Kee Don Choi, Ho June Song, Hwoon‐Yong Jung
Journal of Gastroenterology and Hepatology.2019; 34(3): 561. CrossRef
A large prospective audit of morbidity and mortality associated with feeding gastrostomies in the community
Emily Clarke, Narrie Pitts, Andrew Latchford, Stephen Lewis
Clinical Nutrition.2017; 36(2): 485. CrossRef
Antibacterial gauzes are effective in preventing infections after percutaneous endoscopic gastrostomy placement
Denise Strijbos, Erik J. Schoon, Wouter Curvers, Pieter Friederich, Hajo J. Flink, Arnold Stronkhorst, Lennard P.L. Gilissen
European Journal of Gastroenterology & Hepatology.2016; 28(3): 297. CrossRef
Advances in nutritional delivery interventions
Bryan Silon, John C. Fang
Techniques in Gastrointestinal Endoscopy.2015; 17(4): 152. CrossRef

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11 Crossref

Case Reports

Gastrostomy in a Patient with Situs Inversus Totalis: Hyung Ki Lee, Kwang Bum Cho, Eun Soo Kim, Kyung Sik Park; Clin Endosc 2013;46(6):662-665. Published online November 19, 2013; DOI: https://doi.org/10.5946/ce.2013.46.6.662

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Situs inversus totalis (SIT) is a rare condition in which there is complete right to left reversal of the abdominal and thoracic organs. SIT generally does not bear any pathophysiological significance, and the survival rate of patients with SIT does not differ from that of healthy individuals. However, patients with SIT require a thorough radiological examination to identify the presence of associated anatomic variations before undergoing invasive procedures such as surgery or hemostasis of gastrointestinal hemorrhage because they may have accompanying abnormalities in anatomical structures along with reversed organs. Percutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure that is most commonly performed for the enteral feeding of patients with dysphagia and a normal gastrointestinal function. However, the procedure requires extracaution because minor complications may lead to life-threatening situations due to the underlying illnesses. Here, we report the case of a patient with SIT who underwent a PEG procedure without complications, and review the existing literature on this subject.

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Balakumar Karippaliyil, Milind Karippaliyil, Lisha Karippaliyil
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Omar Elfanagely, Yousef Elfanagely, Abimbola Pratt
International Journal of Surgery Case Reports.2021; 87: 106456. CrossRef
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Rong-Dang Fu, Jie-Yuan Li, Xiao-Hong Zhang, Huan-Wei Chen
Case Reports in Gastroenterology.2020; 14(1): 91. CrossRef
Situs inversus Totalis: Always recall the uncommon
Gregory Tsoucalas, Vasilios Thomaidis, Aliki Fiska
Clinical Case Reports.2019; 7(12): 2575. CrossRef

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A Case of Endoscopic Treatment for Gastrocolocutaneous Fistula as a Complication of Percutaneous Endoscopic Gastrostomy: Jong Ho Hwang, Hyung Wook Kim, Dae Hwan Kang, Choel Woong Choi, Soo Bum Park, Tae Ik Park, Woo Sung Jo, Dong Hyuk Cha; Clin Endosc 2012;45(1):95-98. Published online March 31, 2012; DOI: https://doi.org/10.5946/ce.2012.45.1.95

Abstract PDF PubReader ePub

As a rare complication of percutaneous endoscopic gastroscopy (PEG), a gastrocolocutaneous fistula may occur after PEG placement. This paper reports an interesting case which PEG tube unintentionally penetrated transverse colon during PEG. A 72-year-old female patient who suffered from medullary infarction underwent PEG procedure for enteral nutrition, and fecal materials were observed 6 days after the procedure. Transverse colon located in antero-superior site of stomach was observed through abdominal computed tomography, and also the wrong inserted tube was found through gastroscopy and colonoscopy. Endoscopic treatment for the fistula was performed by the use of hemo-clip and detachable snare, closure of the fistula was finally confirmed 6 days after the endoscopic procedure. Therefore, the gastrocolocutaneous fistula should be considered as one of the complications of PEG when fecal material is observed through PEG tube in a few days after PEG procedure and endoscopic treatment can be feasible in this case.

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Malposition of Percutaneous Endoscopic Gastrostomy (PEG) Tube Through the Transverse Colon: A Novel Approach to Conservative Management
Zachary A Blashinsky, Joel A Calafell
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A Rare Case of Severe Diarrhea: Gastrocolic Fistula Caused by Migration of Percutaneous Endoscopic Gastrostomy Tube
Maria Elena Pugliese, Riccardo Battaglia, Antonio Cerasa, Lucia Francesca Lucca
Healthcare.2023; 11(9): 1263. CrossRef
How far is the endoscopist to blame for a percutaneous endoscopic gastrostomy complication?
George Stavrou, Persefoni Gionga, George Chatziantoniou, Georgios Tzikos, Alexandra Menni, Stavros Panidis, Anne Shrewsbury, Katerina Kotzampassi
World Journal of Gastrointestinal Surgery.2023; 15(5): 940. CrossRef
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Gastrointestinal Endoscopy.2021; 93(6): 1325. CrossRef
Long-Term Gastrocolocutaneous Fistula after Endoscopic Gastrostomy: How Concerned Should We Be?
Gonçalo Nunes, Gabriel Paiva de Oliveira, João Cruz, Carla Adriana Santos, Jorge Fonseca
GE - Portuguese Journal of Gastroenterology.2019; 26(6): 441. CrossRef
Gastrocolocutaneous Fistula: An Unusual Case of Gastrostomy Tube Malfunction with Diarrhea
Junghwan Lee, Jinyoung Kim, Ha il Kim, Chung Ryul Oh, Sungim Choi, Soomin Noh, Hee Kyong Na, Hwoon-Yong Jung
Clinical Endoscopy.2018; 51(2): 196. CrossRef
Endoscopic Closure of a Gastric Perforation Developing as a Complication after Percutaneous Endoscopic Gastrostomy Insertion
Gyu Young Pih, Hee Kyong Na
The Korean Journal of Medicine.2018; 93(3): 291. CrossRef
An unexpected cause of transient diarrhea
Yoen Young Chuah, Yeong Yeh Lee, Tzung Jiun Tsai
Postgraduate Medicine.2017; 129(4): 488. CrossRef
Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy
Jiri Cyrany
World Journal of Gastroenterology.2016; 22(2): 618. CrossRef
Two Cases of Uncommon Complication during Percutaneous Endoscopic Gastrostomy Tube Replacement and Treatment
Hyun Joo Lee, Rok Seon Choung, Min Seon Park, Jeung Hui Pyo, Seung Young Kim, Jong Jin Hyun, Sung Woo Jung, Ja Seol Koo, Sang Woo Lee, Jai Hyun Choi
The Korean Journal of Gastroenterology.2014; 63(2): 120. CrossRef
A Study of Complications Related to Percutaneous Endoscopic Gastrostomy
Hong Jae Kim, Sang Ho Lee, Jae Nam Lee, Seong Pil Jang, Cheol Gu Hwang, Ji Ha Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014; 14(1): 24. CrossRef
Two Cases of Gastrocolocutaneous Fistula with a Long Asymptomatic Period after Percutaneous Endoscopic Gastrostomy
Hyo Sun Kim, Chang Seok Bang, Yeon Soo Kim, Oh Kyung Kwon, Min Sun Park, Jeong Ho Eom, Gwang Ho Baik, Dong Joon Kim
Intestinal Research.2014; 12(3): 251. CrossRef
First report of colonoscopic closure of a gastrocolocutaneous PEG migration with over-the-scope-clip-system
Reto Bertolini
World Journal of Gastroenterology.2014; 20(32): 11439. CrossRef

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The Benefit of Percutaneous Endoscopic Gastrostomy Is Low in Patients with Dementia: YuJin Suh, M.D., Jae Myung Cha, M.D., Joung Il Lee, M.D., Kwang Ro Joo, M.D., Sung Won Jung, M.D., Hyun Phil Shin, M.D. and Soo Woong Kim, M.D.; Korean J Gastrointest Endosc 2010;40(4):229-235. Published online April 30, 2010

Abstract PDF: Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) is beneficial in treatment of stroke or head and neck cancer. The situation for dementia is unknown. Presently, results, complications, and survival of PEG patients with or without dementia were assessed.
Methods
In a retrospective analysis of 67 patients, gender, age, diagnosis, laboratory results, complications, tube change, early death and death were compared in dementia (n=5) and non-dementia (n=62) patients (average age 68.7 years).
Results
Patient clinical characteristics were not different, except for the proportion of gender. Complications occurred in 11 cases (16.4%). Wound infection was the most common complication followed by Mallory-Weiss tear, tube leakage, fever and pneumonia. Twenty six patients (38.8%) died during the follow-up period, and the 30 day mortality rate was 2.7%. Average survival of dementia and non- dementia patients was 12 months and 25 months, respectively. Dementia patients showed a tendency for shorter survival, although it was insignificant (p=0.068). Dementia was the only predictor of mortality that showed significance (p=0.006).
Conclusion
In this study there was a tendency for shorter survival in dementia patients and dementia was the only significant predictor of mortality. (Korean J Gastrointest Endosc 2010;40:229-235)

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Technique, Management and Complications of Percutaneous Endoscopic Gastrostomy: Yun Jeong Lim, M.D. and Chang Heon Yang, M.D.; Korean J Gastrointest Endosc 2009;39(3):119-124. Published online September 30, 2009

Abstract PDF: Percutaneous endoscopic gastrostomy (PEG) is a widely used method for introducing a gastrostomy tube endoscopically to enable enteral feeding in patients who are unable to eat but have a normally functioning gut. The endsopist trained in the techniques for enteral access should be equally acquired the knowledge for monitoring patients and managing the complications arising from the initial gastrostomy procedure. Optimal endoscopic technique, proper monitor, early recognition of impending complication and quick management are important because most of these patients are elderly, debilitated, and chronically ill. In this review, general information about insertion and management of PEG was described based on the our experience of PEG and review of literatures. (Korean J Gastrointest Endosc 2009;39:119-124)

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A Case of Ruptured Left Gastric Artery Pseudoaneurysm Complicating Percutaneous Endoscopic Gastrostomy (PEG): Seong Hun Hong, M.D., Jae Myung Cha, M.D., Joung Il Lee, M.D., Kwang Ro Joo, M.D., Sung Won Jung, M.D., Hyun Phil Shin, M.D. and Deok Ho Nam, M.D.*; Korean J Gastrointest Endosc 2009;39(1):34-37. Published online July 30, 2009

Abstract PDF: Percutaneous endoscopic gastrostomy (PEG) is an effective method for delivering enteral nutrition to patients with dysphagia, cerebrovascular accidents, Parkinsonnism, dementia, and head and neck cancer. PEG is generally regarded as safe and it is associated with low risks of morbidity and mortality. The complications of the PEG are known to be mostly minor and they include wound infection, gastric leakage, bleeding, ileus, pneumoperitoneum and aspiration pneumonia. We recently experienced a ruptured pseudoaneurysm of the left gastric artery, which was occurred as a complication during PEG insertion in a 73-year-old female. To the best of our knowledge, this is the first case report in Korea about successful angiographic embolization for a ruptured pseudoaneurysm of the left gastric artery and this was associated with a PEG procedure. (Korean J Gastrointest Endosc 2009;39:34-37)

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Satisfaction Survey of Care Providers for Enteral Feeding by the Use of Percutaneous Endoscopic Gastrostomy: Suk Jae Hahn, M.D., Yun Jeong Lim, M.D., Chang Heon Yang, M.D. and Jin Ho Lee, M.D.; Korean J Gastrointest Endosc 2009;39(1):8-13. Published online July 30, 2009

Abstract PDF: Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) is a widely used procedure for enteral feeding that is convenient and safe. We investigated the satisfaction of enteral feeding by the use of a nasogastric tube and PEG as well as PEG-related complications.
Methods
A total of 57 patients (121 cases) who underwent PEG in a teaching hospital were investigated about complications based on the use of electronic medical records. Questionnaires comprised of 11 questions were administered by telephone or by direct contact with care providers.
Results
The median interval period of exchange for PEG was 184.94 days. The causes for exchange included regular exchange (36, 41.86%), accidental or self- removal of the PEG tube (26, 30.23%), profuse discharge, rash or infection around the PEG insertion site (13, 15.12%) and PEG tube malfunction (11, 12.79%). The satisfaction index (VAS scale) for the use of the nasogastric tube was 4.32, while the satisfaction index for the use of PEG was 7.72, which indicates that the care providers were more satisfied with nutrition provided by the use of PEG (p <0.0001). The 28 care providers (80.00%) replied that PEG was a good method to maintain a high quality of life.
Conclusions
Care providers had a high degree of satisfaction for the use of PEG. PEG is safe and effective method for enteral nutrition. If continuous education or management to reduce accidental removal and to lessen complications is enforced, higher satisfaction can be expected. (Korean J Gastrointest Endosc 2009;39:8-13)

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A Case of Subcutaneous Emphysema Following Percutaneous Endoscopic Gastrostomy: Gwang Il Seo, M.D., Jeong Rok Lee, M.D., Woo Chul Chung, M.D., Ju Huyn Oak, M.D., Jin Dong Kim, M.D., Chang Nyol Paik, M.D., Kang-Moon Lee, M.D. and Jin Mo Yang, M.D.; Korean J Gastrointest Endosc 2009;38(5):266-269. Published online May 30, 2009

Abstract PDF: Percutaneous endoscopic gastrostomy (PEG) has widely accepted for providing safe, long-term enteral nutrition for patients with swallowing disabilities. Though safe and technically simple, this procedure is often associated with some complications, such as wound infection, bleeding, stroma leaks and tube transposition. Major complications are rare and these include aspiration pneumonia, perforations, peritonitis and necrotizing fasciitis. We report here on a patient who developed extensive subcutaneous emphysema with hemoperitoneum and peritonitis following PEG. Medical treatment without removal of the PEG led to resolution of the emphysema and the peritonitis and successful PEG feeding. (Korean J Gastrointest Endosc 2009;38:266-269)

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A Risk Factor for Wound Infection after Percutaneous Endoscopic Gastrostomy : Decreased Performance Status: Chan Ran You, M.D., Sang Woo Kim, M.D., Chang Nyol Paik, M.D., Jae Myung Park, M.D.,Yu Kyung Cho, M.D., In Seok Lee, M.D., Myung Gyu Choi, M.D., Kyu Yong Choi, M.D. and In Sik Chung M.D.; Korean J Gastrointest Endosc 2007;35(3):133-139. Published online September 30, 2007

Abstract PDF: Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) has been widely used for long term enteral nutrition. The most common complication is peristomal wound infection. The aim of this study is to investigate the risk factors for peristomal wound infection after PEG. Methods: We reviewed the records of 55 patients who had undergone PEG placement at Kangnam St. Mary's hospital via the Pull-string technique. We analyzed the underlying disease, the performance status and the nutritional state of the patients to determine the risk factors for wound infection. Results: Peristomal wound infection after PEG occurred in 20 (36.4%) of the 55 patients. Methicillin resistant Staphylococcus aureus (MRSA) was the most common isolated microorganism. On univariate analysis, the underlying CNS disease, non-malignant disease and a decreased performance status (ECOG 3, 4) were correlated with wound infection. On multivariate analysis, a decreased performance status was an independent risk factor for wound infection after PEG (p=0.007, OR=6.011, CI: 1.64∼22.09). Conclusions: A decreased performance status was an independent risk factor for peristomal wound infection after PEG. (Korean J Gastrointest Endosc 2007;35:133-139)

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The Proper Patient Selection for Percutaneous Endoscopic Gastrostomy according to the Complications and Tube Replacement: Sung Jun Kim, M.D., Won Chang Shin, M.D. and Jin Ho Lee, M.D.; Korean J Gastrointest Endosc 2005;30(2):60-65. Published online February 27, 2005

Abstract PDF: Background
/Aims: Percutaneous endoscopic gastrostomy (PEG) is a commonly-performed procedure for patients with swallowing disabilities. Though safe and technically simple, PEG is often associated with some complications, and occasionally requires tube replacement. The aims of this study were to evaluate the complications and the proper indication of PEG by analyzing the success rate and tube replacement. Methods: We reviewed medical records of 81 patients who underwent initial PEG and 92 patients who underwent tube replacement or removal from January 1995 to December 2003. Results: Underlying diseases included cerebrovascular accident (51%), spinal cord injury (12%), hypoxic brain damage (11%), and head trauma (11%). PEG success rate was 93%. Twenty five patients (31%) showed various complications. Wound infection was the most common (10/25, 40%) complication, and most complications (64%) occurred within 10 days, but 24% of complications occurred 1 month after the procedure. Mean duration for tube placement was 7.3 months. The reasons for tube replacement or removal were worn- out (36 cases, 39%), unwanted self extraction (14 cases, 15%), and death (11 cases, 12%). Conclusions: PEG is a safe and effective method for enteral nutrition. However PEG shows some complications, and occasionally needs tube replacement. It is crucial to select the appropriate patient and to perform careful procedure. (Korean J Gastrointest Endosc 2005;30:60⁣65)

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Massive Gastric Bleeding Occuring after the Replacement of Percutaneous Endoscopic Gastrostomy Tube: Young Mi Kim, M.D., Sang Ook Nam, M.D. and Jae Hong Park, M.D.; Korean J Gastrointest Endosc 2004;28(5):247-250. Published online May 30, 2004

Abstract PDF: Percutaneous endoscopic gastrostomy (PEG) tube placement is preferred one of the standard method for providing enteral nutrition to infants and children with feeding problems. It was introduced into clinical practice in 1980 and now considered as a widely used technique. It is simple to perform and does not require general anesthesia. However, acute complications can occur with the use of PEG tubes such as wound infection, pneumoperitoneum and transient ileus. Because long-term placement of PEG tube is frequently required in pediatric patients with neurologic impairment, late-onset complications should be observed in them. We report a case of massive gastric bleeding occuring after the replacement of the PEG tube in an 8-year-old boy, as one of the late complication of PEG placement. We assumed that the mechanical trauma to hypertrophic gastric mucosa associated with incomplete buried-bumper syndrome was the cause of massive bleeding. (Korean J Gastrointest Endosc 2004;28:247⁣250)

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증례 : 위장관 ; Buried Bumper Syndrome 1예 ( Case Reports : Stomach & Intestine ; A Case of Buried Bumper Syndrome ): Korean J Gastrointest Endosc 1997;17(5):668-673. Published online November 30, 1996

Abstract PDF: Percutaneous endoscopic gastrostomy is used for long-term nutritional support and can be performed with relatively few complications. Among the major and minor complications, migration and erosion of the internal bumper into or through the abdominal wall, so called buried bumper syndrome has been described more recently. We describe a patient in whom internal bumper eroded into stomach wall and was completely covered by gastric epithelium 45 days after gastrostomy placement. The gastrostomy tube itself was patent, and the end still protruded into the lumen of the stomach. But, endoscopy was failed to remove the gastrostomy tube and surgical exploration was required in our case. We experienced a case of buried bumper syndrome after percutaneous endoscopic gastrostomy and report with a review of literatures. (Korean J Gastrointest Endosc 17: 668-672, 1997)

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경피 내시경하 위루술 ( PEG ) 의 장기적 효율성 ( Long Term Efficacy of Percutaneous Endoscopic Gastrostomy ): Korean J Gastrointest Endosc 1992;12(1):29-35. Published online November 30, 1991

Abstract PDF: Since the introduction of Percutaneous Endoscopic Gastrostomy(PEG) into clinical practice by Ponsky in 1980, the endoscopic procedure for the placement of a gastrostomy feeding tube has been markedly developed in the world. In l986, PEG was first described in Korea, thereafter it is widely used in many Korean institutions. But until recently the clinical studies of the long term efficacy of PEG has almost not been reported. (continue...)

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