Published online May 16, 2022. doi: 10.4253/wjge.v14.i5.250
Peer-review started: April 17, 2021
First decision: July 27, 2021
Revised: August 3, 2021
Accepted: April 24, 2022
Article in press: April 24, 2022
Published online: May 16, 2022
Nutritional support is essential in patients who have a limited capability to maintain their body weight. Therefore, oral feeding is the main approach for such patients. When physiological nutrition is not possible, positioning of a nasogastric, nasojejunal tube, or other percutaneous devices may be feasible alternatives. Creating a percutaneous endoscopic gastrostomy (PEG) is a suitable option to be evaluated for patients that need nutritional support for more than 4 wk. Many diseases require nutritional support by PEG, with neurological, oncological, and catabolic diseases being the most common. PEG can be performed endoscopically by various techniques, radiologically or surgically, with different outcomes and related adverse events (AEs). Moreover, some patients that need a PEG placement are fragile and are unable to express their will or sign a written informed consent. These conditions highlight many ethical problems that become difficult to manage as treatment progresses. The aim of this manuscript is to review all current endoscopic techniques for percutaneous access, their indications, postprocedural follow-up, and AEs.
Core Tip: Percutaneous endoscopic gastrostomy (PEG) represents the first choice for long-term enteral nutrition support. The aim of this manuscript is to provide a comprehensive overview of PEG placement, including indications, contraindications, preprocedural clinical assessment, endoscopic techniques, adverse events, and postprocedural follow-up. Furthermore, endoscopic procedures for jejunal nutrition are also addressed. In consideration with the increasing frequency with which PEG placements are requested, this review may be a useful tool for clinical guidance both for endoscopists and physicians in different fields, with a particular focus on appropriateness of the indications and safety of this procedure.