Indications and contraindications for percutaneous endoscopic gastrostomy and jejunostomy

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Progress in the understanding and application of nutritional support has been one of the most significant recent advances in medicine. Currently the benefits of enteral alimentation are being increasingly appreciated. The indications for percutaneous endoscopic gastrostomy (PEG) are enteral access for nutritional support of patients with altered mental status, dysphagia, malnutrition, and aspiration, and for bowel decompression. Contraindications are coagulopathy, pharyngeal or esophageal obstruction preventing endoscopy, psychosis or dementia, and pulmonary or malignant cachexia. PEG is successfully performed in 94% to 100% of cases. The procedural morbidity and mortality rates are 0% to 6.2% and 4.9% to 32%, respectively. PEG tubes have proven to be durable in long-term follow-up. Repeat PEG tube placement is safe and may be performed as an outpatient procedure. The almost uniformly favorable results with PEG tubes have not been shared by percutaneous endoscopic jejunostomy (PEJ) tubes. The indications for PEJ tubes are gastric distention, delayed gastric emptying, previous gastric resection, and aspiration of gastric feedings. Although the success rate is high, the procedural mortality is 0% to 50%, with the incidence of tube failure ranging from 70% to 84% of cases. Aspiration is poorly controlled unless care is taken to position the feeding tube well beyond the ligament of Trietz.

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