Fugazza A, Capogreco A, Cappello A, Nicoletti R, Da Rio L, Galtieri PA, Maselli R, Carrara S, Pellegatta G, Spadaccini M, Vespa E, Colombo M, Khalaf K, Repici A, Anderloni A. Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques. World J Gastrointest Endosc 2022; 14(5): 250-266 [PMID: 35719902 DOI: 10.4253/wjge.v14.i5.250]
Corresponding Author of This Article
Alessandro Fugazza, MD, Medical Assistant, Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Via Manzoni 56, Rozzano 20089, Milan, Italy. alessandro.fugazza@humanitas.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. May 16, 2022; 14(5): 250-266 Published online May 16, 2022. doi: 10.4253/wjge.v14.i5.250
Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques
Alessandro Fugazza, Antonio Capogreco, Annalisa Cappello, Rosangela Nicoletti, Leonardo Da Rio, Piera Alessia Galtieri, Roberta Maselli, Silvia Carrara, Gaia Pellegatta, Marco Spadaccini, Edoardo Vespa, Matteo Colombo, Kareem Khalaf, Alessandro Repici, Andrea Anderloni
Alessandro Fugazza, Antonio Capogreco, Rosangela Nicoletti, Leonardo Da Rio, Piera Alessia Galtieri, Roberta Maselli, Silvia Carrara, Gaia Pellegatta, Marco Spadaccini, Edoardo Vespa, Matteo Colombo, Kareem Khalaf, Alessandro Repici, Andrea Anderloni, Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Rozzano 20089, Milan, Italy
Annalisa Cappello, Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna 40121, Italy
Kareem Khalaf, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20072, Milan, Italy
Author contributions: Fugazza A, Capogreco A, and Cappello A drafted the manuscript; Rosangela Nicoletti R, Da Rio L, Galtieri PA, Maselli R, Carrara S, Pellegatta G, Spadaccini M, Vespa E, Colombo M, and Khalaf K contributed to the acquisition, analysis, or interpretation of data for the work; Repici A and Anderloni A contributed to the critical revision of the manuscript; All authors approved the final version to be published.
Conflict-of-interest statement: All the authors declare that they have no competing interests related to the topic.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alessandro Fugazza, MD, Medical Assistant, Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, Humanitas Research Hospital - IRCCS, Via Manzoni 56, Rozzano 20089, Milan, Italy. alessandro.fugazza@humanitas.it
Received: April 17, 2021 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 Processing time: 393 Days and 20.4 Hours
Abstract
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.
