Difference between revisions of "Percutaneous endoscopic gastrostomy"
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{{Infobox surgical procedure | |||
| anesthesia_type = MAC | |||
| airway = Natural airway | |||
| lines_access = PIV x1 | |||
| monitors = Standard | |||
| considerations_preoperative = | |||
| considerations_intraoperative = | |||
| considerations_postoperative = | |||
}} | |||
A gastrostomy is a surgical procedure where a tube is placed through the abdominal wall and into the stomach. Though there are several ways to insert a gastrostomy tube, the most common technique is a percutaneous endoscopic gastrostomy (PEG). With this method, the stomach is accessed via endoscopy. The abdominal wall and stomach are then punctured under endoscopic guidance. The gastrostomy tube (G-tube) is passed through the mouth, into the stomach, and then through the stomach and abdominal wall through the puncture. The gastrostomy tube balloon in the stomach is then inflated to keep the tube in place and the retention disk on the skin side is adjusted to endure the tube remains at the correct depth.<ref>{{Cite book|last=Jaffe|first=Richard|title=Anesthesiologist's Manuel of Surgical Procedures|publisher=Wolters Kluwer|year=2014|isbn=978-1-4511-7660-5|location=Philadelphia, PA|pages=517}}</ref> | |||
A gastrostomy tube may also be placed directly via a laparotomy as is the case in a Stam or Janeway gastrostomy. As these procedures are more technically involved and typically require general anesthesia, PEG tube placements are the preferred method for most patients.<ref>{{Cite journal|last=Rahnemai-Azar|first=Ata A.|last2=Rahnemaiazar|first2=Amir A.|last3=Naghshizadian|first3=Rozhin|last4=Kurtz|first4=Amparo|last5=Farkas|first5=Daniel T.|date=2014-06-28|title=Percutaneous endoscopic gastrostomy: indications, technique, complications and management|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC4069302/|journal=World Journal of Gastroenterology|volume=20|issue=24|pages=7739–7751|doi=10.3748/wjg.v20.i24.7739|issn=2219-2840|pmc=4069302|pmid=24976711}}</ref> | |||
G-tubes are typically placed for permanent or temporary gastric access that is needed for greater than 30 day, making a nasogastric tube unsustainable. A G-tube is usually placed for enteral access for nutrition and medication or, less often, gastric decompression. Long-term enteral access is needed when there is a neurologic impairment or mechanical impediment that prevents patients from managing oral secretions or increases aspiration risk. These conditions can include, but are not limited to dysphagia from stoke or neurologic disorders, head and neck cancers, trauma, and failure to thrive. In the case of gastric decompression, a patient may have an chronic ileus, poor bowel motility, or obstruction causing nausea, vomiting, or abdominal discomfort. | |||
== Preoperative management == | |||
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> === | |||
{| class="wikitable" | |||
|+ | |||
!System | |||
!Considerations | |||
|- | |||
|Airway | |||
|Aspiration risk | |||
|- | |||
|Neurologic | |||
|Ability to cooperate with MAC sedation | |||
|- | |||
|Cardiovascular | |||
|Hypovolemia due to N/V or poor PO intake | |||
|- | |||
|Pulmonary | |||
| | |||
|- | |||
|Gastrointestinal | |||
|Nutritional status | |||
|- | |||
|Hematologic | |||
| | |||
|- | |||
|Renal | |||
|Electrolyte abnormalities due to GI fluid loss | |||
|- | |||
|Endocrine | |||
| | |||
|- | |||
|Other | |||
| | |||
|} | |||
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | |||
* CMP | |||
* Other labs per H&P | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | |||
Endoscope | |||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | |||
Patient dependent. Consider IV acetaminophen for pre-operative pain control | |||
== Intraoperative management == | |||
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | |||
Standard monitoring | |||
PIV x1 | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | |||
Typically done under MAC sedation | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | |||
Supine | |||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | |||
For MAC, titrate sedatives (propofol infusion), and analgesics (fentanyl) for appropriate depth of anesthesia | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | |||
If GETA used, ensure return of laryngeal reflexes prior to extubation. | |||
== Postoperative management == | |||
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | |||
PACU | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | |||
IV Tylenol, NSAIDS, opiates as indicated | |||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | |||
* Leakage of gastric contents around tube | |||
* Tube dislodgement | |||
* Clogged tube | |||
* Periosteal wound infection | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | |||
{| class="wikitable wikitable-horizontal-scroll" | |||
|+ | |||
! | |||
!Variant 1 | |||
|- | |||
|Unique considerations | |||
|Previous gastric procedures can affect difficulty | |||
|- | |||
|Position | |||
|Supine | |||
|- | |||
|Surgical time | |||
|30-60 minutes | |||
|- | |||
|EBL | |||
|Minimal | |||
|- | |||
|Postoperative disposition | |||
|PACU | |||
|- | |||
|Pain management | |||
|IV pain medication | |||
|- | |||
|Potential complications | |||
|Periostimal leakage, local skin infection | |||
|} | |||
== References == | |||
[[Category:Surgical procedures]] | |||
Latest revision as of 19:48, 16 March 2026
| Anesthesia type |
MAC |
|---|---|
| Airway |
Natural airway |
| Lines and access |
PIV x1 |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
A gastrostomy is a surgical procedure where a tube is placed through the abdominal wall and into the stomach. Though there are several ways to insert a gastrostomy tube, the most common technique is a percutaneous endoscopic gastrostomy (PEG). With this method, the stomach is accessed via endoscopy. The abdominal wall and stomach are then punctured under endoscopic guidance. The gastrostomy tube (G-tube) is passed through the mouth, into the stomach, and then through the stomach and abdominal wall through the puncture. The gastrostomy tube balloon in the stomach is then inflated to keep the tube in place and the retention disk on the skin side is adjusted to endure the tube remains at the correct depth.[1]
A gastrostomy tube may also be placed directly via a laparotomy as is the case in a Stam or Janeway gastrostomy. As these procedures are more technically involved and typically require general anesthesia, PEG tube placements are the preferred method for most patients.[2]
G-tubes are typically placed for permanent or temporary gastric access that is needed for greater than 30 day, making a nasogastric tube unsustainable. A G-tube is usually placed for enteral access for nutrition and medication or, less often, gastric decompression. Long-term enteral access is needed when there is a neurologic impairment or mechanical impediment that prevents patients from managing oral secretions or increases aspiration risk. These conditions can include, but are not limited to dysphagia from stoke or neurologic disorders, head and neck cancers, trauma, and failure to thrive. In the case of gastric decompression, a patient may have an chronic ileus, poor bowel motility, or obstruction causing nausea, vomiting, or abdominal discomfort.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | Aspiration risk |
| Neurologic | Ability to cooperate with MAC sedation |
| Cardiovascular | Hypovolemia due to N/V or poor PO intake |
| Pulmonary | |
| Gastrointestinal | Nutritional status |
| Hematologic | |
| Renal | Electrolyte abnormalities due to GI fluid loss |
| Endocrine | |
| Other |
Labs and studies
- CMP
- Other labs per H&P
Operating room setup
Endoscope
Patient preparation and premedication
Patient dependent. Consider IV acetaminophen for pre-operative pain control
Intraoperative management
Monitoring and access
Standard monitoring
PIV x1
Induction and airway management
Typically done under MAC sedation
Positioning
Supine
Maintenance and surgical considerations
For MAC, titrate sedatives (propofol infusion), and analgesics (fentanyl) for appropriate depth of anesthesia
Emergence
If GETA used, ensure return of laryngeal reflexes prior to extubation.
Postoperative management
Disposition
PACU
Pain management
IV Tylenol, NSAIDS, opiates as indicated
Potential complications
- Leakage of gastric contents around tube
- Tube dislodgement
- Clogged tube
- Periosteal wound infection
Procedure variants
| Variant 1 | |
|---|---|
| Unique considerations | Previous gastric procedures can affect difficulty |
| Position | Supine |
| Surgical time | 30-60 minutes |
| EBL | Minimal |
| Postoperative disposition | PACU |
| Pain management | IV pain medication |
| Potential complications | Periostimal leakage, local skin infection |
References
- ↑ Jaffe, Richard (2014). Anesthesiologist's Manuel of Surgical Procedures. Philadelphia, PA: Wolters Kluwer. p. 517. ISBN 978-1-4511-7660-5.
- ↑ Rahnemai-Azar, Ata A.; Rahnemaiazar, Amir A.; Naghshizadian, Rozhin; Kurtz, Amparo; Farkas, Daniel T. (2014-06-28). "Percutaneous endoscopic gastrostomy: indications, technique, complications and management". World Journal of Gastroenterology. 20 (24): 7739–7751. doi:10.3748/wjg.v20.i24.7739. ISSN 2219-2840. PMC 4069302. PMID 24976711.
Top contributors: Chelsea Rogers, Mitchel DeVita and Chris Rishel