Post written by Carlos Paolo D. Francisco, MD, FPCP, DPSG, DPSDE, from Singapore General Hospital, Singapore, and St. Luke’s Medical Center, Global City, Philippines.

PEG is the preferred feeding route for patients requiring long-term enteral nutrition. The procedure involves percutaneously placing a tube into the stomach with the assistance of endoscopy, as described by Gauderer et al¹ in 1980. It is the better alternative to surgical methods because it is safer and more cost-effective, with lower procedure-related mortality and adverse events.

The main indications for PEG include enteral feeding in patients with inadequate oral intake, neurodegenerative conditions, head and neck tumors, and gastric decompression. Various methods of PEG tube insertion—such as the pull, push, and introducer techniques—are described in the literature. The pull technique is the standard method used in many cases, but it is contraindicated in patients with head and neck tumors because of the risk of tumor seeding.

In this video, we present a case of a patient with post-stroke neurogenic dysphagia who underwent pull-type PEG tube insertion. Although the procedure is relatively safe, adverse events such as infection, perforation, and bleeding may still occur. Implementing a sterile field and administering prophylactic IV antibiotics are important measures to prevent procedure-related infections.

PEG has been established for decades and remains one of the most performed endoscopic procedures worldwide. It is a mandatory component of the American Society for Gastrointestinal Endoscopy gastroenterology core curriculum for fellowship training.

Therefore, it is imperative for endoscopists to acquire proficiency and competency in PEG insertion techniques and adverse event management. Our video breaks down the steps involved in performing pull-type PEG, enhancing understanding, retention, and promoting consistency in the learning process, particularly among trainees.

Confirm the position of the internal bolster and ensure it is close to the gastric wall. Then slide the external bolster and position it 1 cm from the skin. Insert the clamp and cut the excess tube at the X mark.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

1. Gauderer MW, Ponsky JL, Izant RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980;15:872-5. ↩︎