Is PEG surgery suitable for everyone?
Of course, the answer is no.
Q: What are the indications of PEG?
A: For patients with moderate-to-severe protein-calorie malnutrition who require long-term feeding (greater than 30 days), a PEG tube is recommended.To get informed consent, a clinician must take into account the patient's actual life expectancy and objectives, diagnosis, and ethical preferences. These factors must also be communicated with the patient and family. Under some circumstances, the patient's quality of life is enhanced in addition to their survival and nutritional health. Patients are referred for PEG placement for a variety of conditions, such as stroke, multiple sclerosis, Parkinson's disease, motor neuron disease, cerebral tumors, head and neck cancers, burns, cystic fibrosis, esophageal cancer, abdominal cancer, prolonged coma, neurologic disorders, HIV/AIDS, cystic fibrosis, Crohn's disease, short bowel syndrome, and distal gastric obstruction.The primary indications for PEG placement in these conditions include dysphagia, impaired self-feeding, obstruction of the gastrointestinal tract preventing enteral access, malnutrition secondary to malignancy or reduced oral nutrition supplementation from radiotherapy or chemotherapy, or the need for gastric decompression.
Q: What are the contraindications of PEG?
A: Absolute contraindications to PEG tube placement include the following:
Serious coagulation disorders (INR greater than 1.5, PTT greater than 50 seconds, PLT less than 50,000/mm3)
Hemodynamic instability
Sepsis
Severe ascites
Peritonitis
Abdominal wall infection at the placement site
Peritoneal carcinomatosis
Lack of a safe tract for percutaneous insertion
Gastric outlet obstruction and severe gastroparesis (if used for feeding)
History of total gastrectomy
Prolonged ventilation assistance
Lack of informed consent
Relative contraindications include a history of partial gastrectomy and large intrathoracic hiatal hernia.
