Percutaneous Endoscopic Gastrostomy (PEG): Indications
Long-term feeding
 Mechanical Dysfunction
   Esophageal obstruction
   Swallowing disorder
   Facial fractures
 Neurologic impairment
   Stroke
   Closed head injury
Replace nasoenteric feeding tube
 Reduce risk of aspiration, sinusitis
 Facilitates tube replacement for mechanical problems
Permit transfer to long term facility
Decompressive tube for palliation (carcinomatosis,gastric obstruction, severe diabetic gastroparesis)
Access for repeated endoscopic or surgical instrumentation (e.g. bougie)
Recirculation of bile-Fistula, biliary drain
Gastric volvulus

Contraindications
Poorly selected populations have 30 day mortality of up to 50% after PEG
 Exception: palliative, for decompression
Inability to perform upper endoscopy
  Obstructing esophageal tumor
  Stricture
Ascites
Inability to appose gastrotomy to anterior abdominal wall
  Previous subtotal gastric resection
  Hepatomegaly, esp left lobe

Complications of PEG
Pneumoperitoneum and Peritonitis
Dislodgement of PEG Tube
Buried Bumper Syndrome
Peristomal Wound Infection
Necrotizing Fasciitis
Gastrocolocutaneous Fistula

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