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Endoscopy 2021; 53(02): 178-195
DOI: 10.1055/a-1331-8080
Guideline

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Paraskevas Gkolfakis
 1   Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
,
Marianna Arvanitakis
 1   Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
,
Edward J. Despott
 2   Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, London, United Kingdom
,
Asuncion Ballarin
 1   Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
,
Torsten Beyna 
 3   Department of Gastroenterology and Therapeutic Endoscopy, Evangelisches Krankenhaus Düsseldorf, Germany
,
Kurt Boeykens
 4   Nutrition Support Team, AZ Nikolaas Hospital, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium
,
Peter Elbe
 5   Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
 6   Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
,
Ingrid Gisbertz
 7   Department of Gastroenterology, Bernhoven Hospital, Uden, the Netherlands
,
Alice Hoyois
 1   Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
,
Ofelia Mosteanu
 8   Department of Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
David S. Sanders
 9   Academic Unit of Gastroenterology, Royal Hallamshire Hospital & University of Sheffield, United Kingdom
,
Peter T. Schmidt
10   Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
11   Department of Medicine, Ersta Hospital, Stockholm, Sweden
,
Stéphane M. Schneider
12   Université Côte d’Azur, Centre Hospitalier Universitaire de Nice, Gastroentérologie et Nutrition, Nice, France
,
Jeanin E. van Hooft
13   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
› Author Affiliations
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Main recommendations

ESGE recommends the “pull” technique as the standard method for percutaneous endoscopic gastrostomy (PEG) placement.

Strong recommendation, low quality evidence.

ESGE recommends the direct percutaneous introducer (“push”) technique for PEG placement in cases where the “pull” method is contraindicated, for example in severe esophageal stenosis or in patients with head and neck cancer (HNC) or esophageal cancer.

Strong recommendation, low quality evidence.

ESGE recommends the intravenous administration of a prophylactic single dose of a beta-lactam antibiotic (or appropriate alternative antibiotic, in the case of allergy) to decrease the risk of post-procedural wound infection.

Strong recommendation, moderate quality evidence.

ESGE recommends that inadvertent insertion of a nasogastric tube (NGT) into the respiratory tract should be considered a serious but avoidable adverse event (AE).

Strong recommendation, low quality evidence.

ESGE recommends that each institution should have a dedicated protocol to confirm correct positioning of NGTs placed “blindly” at the patient’s bedside; this should include: radiography, pH testing of the aspirate, and end-tidal carbon dioxide monitoring, but not auscultation alone.

Strong recommendation, low quality evidence.

ESGE recommends confirmation of correct NGT placement by radiography in high-risk patients (intensive care unit [ICU] patients or those with altered consciousness or absent gag/cough reflex).

Strong recommendation, low quality evidence.

ESGE recommends that EN may be started within 3 – 4 hours after uncomplicated placement of a PEG or PEG-J.

Strong recommendation, high quality evidence.

ESGE recommends that daily tube mobilization (pushing inward) along with a loose position of the external PEG bumper (1 – 2 cm from the abdominal wall) could mitigate the risk of development of buried bumper syndrome.

Strong recommendation, low quality evidence.

Tables 1s – 3s



Publication History

Article published online:
21 December 2020

© 2020. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Bischoff SC, Austin P, Boeykens K. et al. ESPEN guideline on home enteral nutrition. Clin Nutr 2020; 39: 5-22
    CrossrefPubMedGoogle Scholar
  • 2 Kurien M, Westaby D, Romaya C. et al. National survey evaluating service provision for percutaneous endoscopic gastrostomy within the UK. Scand J Gastroenterol 2011; 46: 1519-1524
    CrossrefPubMedGoogle Scholar
  • 3 Hucl T, Spicak J. Complications of percutaneous endoscopic gastrostomy. Best Pract Res Clin Gastroenterol 2016; 30: 769-781
    CrossrefPubMedGoogle Scholar
  • 4 Arvanitakis M, Gkolfakis P, Despott EJ. et al. Endoscopic management of enteral tubes in adult patients – Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52: 81-92
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Dumonceau JM, Hassan C, Riphaus A. et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline Development Policy. Endoscopy 2012; 44: 626-629
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Palmer LB, McClave SA, Bechtold ML. et al. Tips and tricks for deep jejunal enteral access: modifying techniques to maximize success. Curr Gastroenterol Rep 2014; 16: 409
    CrossrefPubMedGoogle Scholar
  • 7 Hirdes MM, Monkelbaan JF, Haringman JJ. et al. Endoscopic clip-assisted feeding tube placement reduces repeat endoscopy rate: results from a randomized controlled trial. Am J Gastroenterol 2012; 107: 1220-1227
    CrossrefPubMedGoogle Scholar
  • 8 ASGE Technology Committee. Kwon RS, Banerjee S, Desilets D. et al. Enteral nutrition access devices. Gastrointest Endosc 2010; 72: 236-248
    CrossrefPubMedGoogle Scholar
  • 9 Gauderer MW, Ponsky JL, Izant RJ. et al. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980; 15: 872-875
    CrossrefPubMedGoogle Scholar
  • 10 Loser C, Aschl G, Hebuterne X. et al. ESPEN guidelines on artificial enteral nutrition – percutaneous endoscopic gastrostomy (PEG). Clin Nutr 2005; 24: 848-861
    CrossrefPubMedGoogle Scholar
  • 11 Stiegmann GV, Goff JS, Silas D. et al. Endoscopic versus operative gastrostomy: final results of a prospective randomized trial. Gastrointest Endosc 1990; 36: 1-5
    CrossrefPubMedGoogle Scholar
  • 12 Larson DE, Burton DD, Schroeder KW. et al. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology 1987; 93: 48-52
    CrossrefPubMedGoogle Scholar
  • 13 Hull MA, Rawlings J, Murray FE. et al. Audit of outcome of long-term enteral nutrition by percutaneous endoscopic gastrostomy. Lancet 1993; 341: 869-872
    CrossrefPubMedGoogle Scholar
  • 14 Russell TR, Brotman M, Norris F. Percutaneous gastrostomy. A new simplified and cost-effective technique. Am J Surg 1984; 148: 132-137
    CrossrefPubMedGoogle Scholar
  • 15 Siu J, Fuller K, Nadler A. et al. Metastasis to gastrostomy sites from upper aerodigestive tract malignancies: a systematic review and meta-analysis. Gastrointest Endosc 2020; 91: 1005-1014 e1017
    CrossrefPubMedGoogle Scholar
  • 16 Dewald CL, Hiette PO, Sewall LE. et al. Percutaneous gastrostomy and gastrojejunostomy with gastropexy: experience in 701 procedures. Radiology 1999; 211: 651-656
    CrossrefPubMedGoogle Scholar
  • 17 Chadha KS, Thatikonda C, Schiff M. et al. Outcomes of percutaneous endoscopic gastrostomy tube placement using a T-fastener gastropexy device in head and neck and esophageal cancer patients. Nutr Clin Pract 2010; 25: 658-662
    CrossrefPubMedGoogle Scholar
  • 18 Dormann AJ, Glosemeyer R, Leistner U. et al. Modified percutaneous endoscopic gastrostomy (PEG) with gastropexy – early experience with a new introducer technique. Z Gastroenterol 2000; 38: 933-938
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Shastri YM, Hoepffner N, Tessmer A. et al. New introducer PEG gastropexy does not require prophylactic antibiotics: multicenter prospective randomized double-blind placebo-controlled study. Gastrointest Endosc 2008; 67: 620-628
    CrossrefPubMedGoogle Scholar
  • 20 Itkin M, DeLegge MH, Fang JC. et al. Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, with endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Gastroenterology 2011; 141: 742-765
    CrossrefPubMedGoogle Scholar
  • 21 Hogan RB, DeMarco DC, Hamilton JK. et al. Percutaneous endoscopic gastrostomy – to push or pull. A prospective randomized trial. Gastrointest Endosc 1986; 32: 253-258
    CrossrefPubMedGoogle Scholar
  • 22 Sartori S, Trevisani L, Nielsen I. et al. Percutaneous endoscopic gastrostomy placement using the pull-through or push-through techniques: is the second pass of the gastroscope necessary?. Endoscopy 1996; 28: 686-688
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Dormann AJ, Huchzermeyer H. Endoscopic techniques for enteral nutrition: standards and innovations. Dig Dis 2002; 20: 145-153
    CrossrefPubMedGoogle Scholar
  • 24 Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World J Gastroenterol 2014; 20: 8505-8524
    CrossrefPubMedGoogle Scholar
  • 25 DeLegge MH, Patrick P, Gibbs R. Percutaneous endoscopic gastrojejunostomy with a tapered tip, nonweighted jejunal feeding tube: improved placement success. Am J Gastroenterol 1996; 91: 1130-1134
    PubMedGoogle Scholar
  • 26 Adler DG, Gostout CJ, Baron TH. Percutaneous transgastric placement of jejunal feeding tubes with an ultrathin endoscope. Gastrointest Endosc 2002; 55: 106-110
    CrossrefPubMedGoogle Scholar
  • 27 Baskin W, Johanson JF. Trans-PEG ultra thin endoscopy for PEG/J placement. Gastrointest Endosc 2003; 57: 146 ; author reply 146–147
    CrossrefPubMedGoogle Scholar
  • 28 Leichus L, Patel R, Johlin F. Percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ) tube placement: a novel approach. Gastrointest Endosc 1997; 45: 79-81
    CrossrefPubMedGoogle Scholar
  • 29 MacFadyen BV Jr, Catalano MF, Raijman I. et al. Percutaneous endoscopic gastrostomy with jejunal extension: a new technique. Am J Gastroenterol 1992; 87: 725-728
    PubMedGoogle Scholar
  • 30 Bumpers HL, Luchette FA, Doerr RJ. et al. A simple technique for insertion of PEJ via PEG. Surg Endosc 1994; 8: 121-123
    CrossrefPubMedGoogle Scholar
  • 31 Parasher VK, Abramowicz CJ, Bell C. et al. Successful placement of percutaneous gastrojejunostomy using steerable glidewire – a modified controlled push technique. Gastrointest Endosc 1995; 41: 52-55
    CrossrefPubMedGoogle Scholar
  • 32 DeLegge MH, Duckworth Jr PF, McHenry Jr L. et al. Percutaneous endoscopic gastrojejunostomy: a dual center safety and efficacy trial. JPEN J Parenter Enteral Nutr 1995; 19: 239-243
    CrossrefPubMedGoogle Scholar
  • 33 Udorah MO, Fleischman MW, Bala V. et al. Endoscopic clips prevent displacement of intestinal feeding tubes: a long-term follow-up study. Dig Dis Sci 2010; 55: 371-374
    CrossrefPubMedGoogle Scholar
  • 34 Fan AC, Baron TH, Rumalla A. et al. Comparison of direct percutaneous endoscopic jejunostomy and PEG with jejunal extension. Gastrointest Endosc 2002; 56: 890-894
    CrossrefPubMedGoogle Scholar
  • 35 Maple JT, Petersen BT, Baron TH. et al. Direct percutaneous endoscopic jejunostomy: outcomes in 307 consecutive attempts. Am J Gastroenterol 2005; 100: 2681-2688
    CrossrefPubMedGoogle Scholar
  • 36 Toussaint E, Van Gossum A, Ballarin A. et al. Percutaneous endoscopic jejunostomy in patients with gastroparesis following lung transplantation: feasibility and clinical outcome. Endoscopy 2012; 44: 772-775
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Mellert J, Naruhn MB, Grund KE. et al. Direct endoscopic percutaneous jejunostomy (EPJ). Clinical results. Surg Endosc 1994; 8: 867-869 ; discussion 869–870
    CrossrefPubMedGoogle Scholar
  • 38 Simoes PK, Woo KM, Shike M. et al. Direct percutaneous endoscopic jejunostomy: procedural and nutrition outcomes in a large patient cohort. JPEN J Parenter Enteral Nutr 2018; 42: 898-906
    CrossrefPubMedGoogle Scholar
  • 39 Aktas H, Mensink PB, Kuipers EJ. et al. Single-balloon enteroscopy-assisted direct percutaneous endoscopic jejunostomy. Endoscopy 2012; 44: 210-212
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Despott EJ, Gabe S, Tripoli E. et al. Enteral access by double-balloon enteroscopy: an alternative method of direct percutaneous endoscopic jejunostomy placement. Dig Dis Sci 2011; 56: 494-498
    CrossrefPubMedGoogle Scholar
  • 41 Karhadkar AS, Rengen MR, Dubin EH. et al. Direct percutaneous endoscopic jejunostomy tube placement using a fine needle for jejunal anchoring. Endoscopy 2006; 38: 952
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Adachi Y, Akino K, Mita H. et al. Systemic prophylactic antibiotics for the modified introducer method for percutaneous endoscopic gastrostomy: a prospective, randomized, double-blind study. J Clin Gastroenterol 2016; 50: 727-732
    CrossrefPubMedGoogle Scholar
  • 43 Blomberg J, Lagergren P, Martin L. et al. Novel approach to antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): randomised controlled trial. BMJ 2010; 341: c3115
    CrossrefPubMedGoogle Scholar
  • 44 Radhakrishnan NV, Shenoy AH, Cartmill I. et al. Addition of local antiseptic spray to parenteral antibiotic regimen reduces the incidence of stomal infection following percutaneous endoscopic gastrostomy: A randomized controlled trial. Eur J Gastroenterol Hepatol 2006; 18: 1279-1284
    CrossrefPubMedGoogle Scholar
  • 45 Saadeddin A, Freshwater DA, Fisher NC. et al. Antibiotic prophylaxis for percutaneous endoscopic gastrostomy for non-malignant conditions: a double-blind prospective randomized controlled trial. Aliment Pharmacol Ther 2005; 22: 565-570
    CrossrefPubMedGoogle Scholar
  • 46 Panigrahi H, Shreeve DR, Tan WC. et al. Role of antibiotic prophylaxis for wound infection in percutaneous endoscopic gastrostomy (PEG): result of a prospective double-blind randomized trial. J Hosp Infect 2002; 50: 312-315
    CrossrefPubMedGoogle Scholar
  • 47 Dormann AJ, Wigginghaus B, Risius H. et al. Antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG) – results from a prospective randomized multicenter trial. Z Gastroenterol 2000; 38: 229-234
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Ahmad I, Mouncher A, Abdoolah A. et al. Antibiotic prophylaxis for percutaneous endoscopic gastrostomy – a prospective, randomised, double-blind trial. Aliment Pharmacol Ther 2003; 18: 209-215
    CrossrefPubMedGoogle Scholar
  • 49 Preclik G, Grune S, Leser HG. et al. Prospective, randomised, double blind trial of prophylaxis with single dose of co-amoxiclav before percutaneous endoscopic gastrostomy. BMJ 1999; 319: 881-884
    CrossrefPubMedGoogle Scholar
  • 50 Gossner L, Keymling J, Hahn EG. et al. Antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): a prospective randomized clinical trial. Endoscopy 1999; 31: 119-124
    Article in Thieme ConnectPubMedGoogle Scholar
  • 51 Akkersdijk WL, van Bergeijk JD, van Egmond T. et al. Percutaneous endoscopic gastrostomy (PEG): comparison of push and pull methods and evaluation of antibiotic prophylaxis. Endoscopy 1995; 27: 313-316
    Article in Thieme ConnectPubMedGoogle Scholar
  • 52 Sturgis TM, Yancy W, Cole JC. et al. Antibiotic prophylaxis in percutaneous endoscopic gastrostomy. Am J Gastroenterol 1996; 91: 2301-2304
    PubMedGoogle Scholar
  • 53 Jain NK, Larson DE, Schroeder KW. et al. Antibiotic prophylaxis for percutaneous endoscopic gastrostomy. A prospective, randomized, double-blind clinical trial. Ann Intern Med 1987; 107: 824-828
    CrossrefPubMedGoogle Scholar
  • 54 Jonas SK, Neimark S, Panwalker AP. Effect of antibiotic prophylaxis in percutaneous endoscopic gastrostomy. Am J Gastroenterol 1985; 80: 438-441
    PubMedGoogle Scholar
  • 55 Jafri NS, Mahid SS, Minor KS. et al. Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy. Aliment Pharmacol Ther 2007; 25: 647-656
    CrossrefPubMedGoogle Scholar
  • 56 Lipp A, Lusardi G. Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy. Cochrane Database Syst Rev 2013; DOI: 10.1002/14651858.CD005571.pub3.
    CrossrefPubMedGoogle Scholar
  • 57 ASGE Standards of Practice Committee. Khashab MA, Chithadi KV, Acosta RD. et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc 2015; 81: 81-89
    CrossrefPubMedGoogle Scholar
  • 58 Vujasinovic M, Ingre C, Baldaque Silva F. et al. Complications and outcome of percutaneous endoscopic gastrostomy in a high-volume centre. Scand J Gastroenterol 2019; 54: 513-518
    CrossrefPubMedGoogle Scholar
  • 59 DeLegge M. Gastrostomy tubes: Complications and their management. UpToDate. https://www.uptodate.com/contents/gastrostomy-tubes-complications-and-their-management/print#!
    Google Scholar
  • 60 Singh A, Gelrud A. Adverse events associated with percutaneous enteral access. Gastrointest Endosc Clin N Am 2015; 25: 71-82
    CrossrefPubMedGoogle Scholar
  • 61 Sutcliffe J, Wigham A, McEniff N. et al. CIRSE standards of practice guidelines on gastrostomy. Cardiovasc Intervent Radiol 2016; 39: 973-987
    CrossrefPubMedGoogle Scholar
  • 62 Toussaint E, Van Gossum A, Ballarin A. et al. Enteral access in adults. Clin Nutr 2015; 34: 350-358
    CrossrefPubMedGoogle Scholar
  • 63 Delgado AAA, de Moura DTH, Ribeiro IB. et al. Propofol vs traditional sedatives for sedation in endoscopy: A systematic review and meta-analysis. World J Gastrointest Endosc 2019; 11: 573-588
    CrossrefPubMedGoogle Scholar
  • 64 Metheny NA, Krieger MM, Healey F. et al. A review of guidelines to distinguish between gastric and pulmonary placement of nasogastric tubes. Heart Lung 2019; 48: 226-235
    CrossrefPubMedGoogle Scholar
  • 65 Rassias AJ, Ball PA, Corwin HL. A prospective study of tracheopulmonary complications associated with the placement of narrow-bore enteral feeding tubes. Crit Care 1998; 2: 25-28
    CrossrefPubMedGoogle Scholar
  • 66 Sorokin R, Gottlieb JE. Enhancing patient safety during feeding-tube insertion: a review of more than 2,000 insertions. JPEN J Parenter Enteral Nutr 2006; 30: 440-445
    CrossrefPubMedGoogle Scholar
  • 67 Lai CW, Barlow R, Barnes M. et al. Bedside placement of nasojejunal tubes: a randomised-controlled trial of spiral- vs straight-ended tubes. Clin Nutr 2003; 22: 267-270
    CrossrefPubMedGoogle Scholar
  • 68 Wojtowycz MM, Arata Jr JA, Micklos TJ. et al. CT findings after uncomplicated percutaneous gastrostomy. AJR Am J Roentgenol 1988; 151: 307-309
    CrossrefPubMedGoogle Scholar
  • 69 Singh D, Laya AS, Vaidya OU. et al. Risk of bleeding after percutaneous endoscopic gastrostomy (PEG). Dig Dis Sci 2012; 57: 973-980
    CrossrefPubMedGoogle Scholar
  • 70 Wiggins TF, Kaplan R, DeLegge MH. Acute hemorrhage following transhepatic PEG tube placement. Dig Dis Sci 2007; 52: 167-169
    CrossrefPubMedGoogle Scholar
  • 71 Paski SC, Dominitz JA. Endoscopic solutions to challenging enteral feeding problems. Curr Opin Gastroenterol 2012; 28: 427-431
    CrossrefPubMedGoogle Scholar
  • 72 Westaby D, Young A, O’Toole P. et al. The provision of a percutaneously placed enteral tube feeding service. Gut 2010; 59: 1592-1605
    CrossrefPubMedGoogle Scholar
  • 73 Turgay AS, Khorshid L. Effectiveness of the auscultatory and pH methods in predicting feeding tube placement. J Clin Nurs 2010; 19: 1553-1559
    CrossrefPubMedGoogle Scholar
  • 74 Metheny NA, Meert KL. Monitoring feeding tube placement. Nutr Clin Pract 2004; 19: 487-495
    CrossrefPubMedGoogle Scholar
  • 75 Boullata JI, Carrera AL, Harvey L. et al. ASPEN safe practices for enteral nutrition therapy [Formula: see text]. JPEN J Parenter Enteral Nutr 2017; 41: 15-103
    CrossrefPubMedGoogle Scholar
  • 76 Burgos R, Breton I, Cereda E. et al. ESPEN guideline clinical nutrition in neurology. Clin Nutr 2018; 37: 354-396
    CrossrefPubMedGoogle Scholar
  • 77 Rowat AM, Graham C, Dennis M. Diagnostic accuracy of a pH stick, modified to detect gastric lipase, to confirm the correct placement of nasogastric tubes. BMJ Open Gastroenterol 2018; 5: e000218
    CrossrefPubMedGoogle Scholar
  • 78 Rowat AM, Graham C, Dennis M. Study to determine the likely accuracy of pH testing to confirm nasogastric tube placement. BMJ Open Gastroenterol 2018; 5: e000211
    CrossrefPubMedGoogle Scholar
  • 79 Chau JP, Lo SH, Thompson DR. et al. Use of end-tidal carbon dioxide detection to determine correct placement of nasogastric tube: a meta-analysis. Int J Nurs Stud 2011; 48: 513-521
    CrossrefPubMedGoogle Scholar
  • 80 Torsy T, Saman R, Boeykens K. et al. Comparison of two methods for estimating the tip position of a nasogastric feeding tube: a randomized controlled trial. Nutr Clin Pract 2018; 33: 843-850
    CrossrefPubMedGoogle Scholar
  • 81 Maple JT, Petersen BT, Baron TH. et al. Abdominal CT as a predictor of outcome before attempted direct percutaneous endoscopic jejunostomy. Gastrointest Endosc 2006; 63: 424-430
    CrossrefPubMedGoogle Scholar
  • 82 Bechtold ML, Matteson ML, Choudhary A. et al. Early versus delayed feeding after placement of a percutaneous endoscopic gastrostomy: a meta-analysis. Am J Gastroenterol 2008; 103: 2919-2924
    CrossrefPubMedGoogle Scholar
  • 83 Szary NM, Arif M, Matteson ML. et al. Enteral feeding within three hours after percutaneous endoscopic gastrostomy placement: a meta-analysis. J Clin Gastroenterol 2011; 45: e34-38
    CrossrefPubMedGoogle Scholar
  • 84 Vyawahare MA, Shirodkar M, Gharat A. et al. A comparative observational study of early versus delayed feeding after percutaneous endoscopic gastrostomy. Indian J Gastroenterol 2013; 32: 366-368
    CrossrefPubMedGoogle Scholar
  • 85 Anderloni A, Di Leo M, Barzaghi F. et al. Complications and early mortality in percutaneous endoscopic gastrostomy placement in lombardy: A multicenter prospective cohort study. Dig Liver Dis 2019; 51: 1380-1387
    CrossrefPubMedGoogle Scholar
  • 86 Schneider AS, Schettler A, Markowski A. et al. Complication and mortality rate after percutaneous endoscopic gastrostomy are low and indication-dependent. Scand J Gastroenterol 2014; 49: 891-898
    CrossrefPubMedGoogle Scholar
  • 87 Pih GY, Na HK, Ahn JY. et al. Risk factors for complications and mortality of percutaneous endoscopic gastrostomy insertion. BMC Gastroenterol 2018; 18: 101
    CrossrefPubMedGoogle Scholar
  • 88 Blomberg J, Lagergren P, Martin L. et al. Albumin and C-reactive protein levels predict short-term mortality after percutaneous endoscopic gastrostomy in a prospective cohort study. Gastrointest Endosc 2011; 73: 29-36
    CrossrefPubMedGoogle Scholar
  • 89 Sbeit W, Kadah A, Mari A. et al. Simple bedside predictors of survival after percutaneous gastrostomy tube insertion. Can J Gastroenterol Hepatol 2019; 2019: 1532918
    CrossrefPubMedGoogle Scholar
  • 90 Kara O, Kizilarslanoglu MC, Canbaz B. et al. Survival after percutaneous endoscopic gastrostomy in older adults with neurologic disorders. Nutr Clin Pract 2016; 31: 799-804
    CrossrefPubMedGoogle Scholar
  • 91 Clarke E, Pitts N, Latchford A. et al. A large prospective audit of morbidity and mortality associated with feeding gastrostomies in the community. Clin Nutr 2017; 36: 485-490
    CrossrefPubMedGoogle Scholar
  • 92 Lee C, Im JP, Kim JW. et al. Risk factors for complications and mortality of percutaneous endoscopic gastrostomy: a multicenter, retrospective study. Surg Endosc 2013; 27: 3806-3815
    CrossrefPubMedGoogle Scholar
  • 93 Barbosa M, Magalhaes J, Marinho C. et al. Predictive factors of early mortality after percutaneous endoscopic gastrostomy placement: The importance of C-reactive protein. Clin Nutr ESPEN 2016; 14: 19-23
    CrossrefPubMedGoogle Scholar
  • 94 Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R. et al. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 2014; 20: 7739-7751
    CrossrefPubMedGoogle Scholar
  • 95 Zopf Y, Konturek P, Nuernberger A. et al. Local infection after placement of percutaneous endoscopic gastrostomy tubes: a prospective study evaluating risk factors. Can J Gastroenterol 2008; 22: 987-991
    CrossrefPubMedGoogle Scholar
  • 96 Krishna S, Singh S, Dinesh KR. et al. Percutaneous endoscopic gastrostomy (PEG) site infections: a clinical and microbiological study from university teaching hospital, India. J Infect Prev 2015; 16: 113-116
    CrossrefPubMedGoogle Scholar
  • 97 Artul S, Nseir W, Assaf V. et al. Abdominal wall necrotising fasciitis due to dislodged percutaneous endoscopic gastrostomy tube. BMJ Case Rep 2014; DOI: 10.1136/bcr-2013-201346.
    CrossrefPubMedGoogle Scholar
  • 98 MacLean AA, Miller G, Bamboat ZM. et al. Abdominal wall necrotizing fasciitis from dislodged percutaneous endoscopic gastrostomy tubes: a case series. Am Surg 2004; 70: 827-831
    CrossrefPubMedGoogle Scholar
  • 99 Klein S, Heare BR, Soloway RD. The “buried bumper syndrome”: a complication of percutaneous endoscopic gastrostomy. Am J Gastroenterol 1990; 85: 448-451
    Google Scholar
  • 100 El AZ, Arvanitakis M, Ballarin A. et al. Buried bumper syndrome: low incidence and safe endoscopic management. Acta Gastroenterol Belg 2011; 74: 312-316
    PubMedGoogle Scholar
  • 101 Chung RS, Schertzer M. Pathogenesis of complications of percutaneous endoscopic gastrostomy. A lesson in surgical principles. Am Surg 1990; 56: 134-137
    PubMedGoogle Scholar
  • 102 McClave SA, Chang WK. Complications of enteral access. Gastrointest Endosc 2003; 58: 739-751
    CrossrefPubMedGoogle Scholar
  • 103 Cyrany J, Rejchrt S, Kopacova M, Bures J. Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy. World J Gastroenterol 2016; 22: 618-627
    CrossrefPubMedGoogle Scholar
  • 104 Mueller-Gerbes D, Hartmann B, Lima JP. et al. Comparison of removal techniques in the management of buried bumper syndrome: a retrospective cohort study of 82 patients. Endosc Int Open 2017; 5: E603-E607
    Article in Thieme ConnectPubMedGoogle Scholar
  • 105 Boyd JW, DeLegge MH, Shamburek RD. et al. The buried bumper syndrome: a new technique for safe, endoscopic PEG removal. Gastrointest Endosc 1995; 41: 508-511
    CrossrefPubMedGoogle Scholar
  • 106 Gencosmanoglu R, Koc D, Tozun N. The buried bumper syndrome: migration of internal bumper of percutaneous endoscopic gastrostomy tube into the abdominal wall. J Gastroenterol 2003; 38: 1077-1080
    CrossrefPubMedGoogle Scholar
  • 107 Costa D, Despott EJ, Lazaridis N. et al. Minimally invasive endoscopic management of buried bumper syndrome by use of a novel dedicated resection device. VideoGIE 2019; 4: 366-368
    CrossrefPubMedGoogle Scholar
  • 108 Hindryckx P, Dhooghe B, Wannhoff A. A novel device for the endoscopic management of buried bumper syndrome. Endoscopy 2019; 51: 689-693
    Article in Thieme ConnectPubMedGoogle Scholar
  • 109 Wolpert LE, Summers DM, Tsang A. Novel endoscopic management of buried bumper syndrome in percutaneous endoscopic gastrostomy: The Olympus HookKnife. World J Gastroenterol 2017; 23: 6546-6548
    CrossrefPubMedGoogle Scholar
  • 110 Casper M, Lammert F. How to improve success rates of endoscopic management for buried bumper syndrome. QJM 2018; 111: 467-472
    CrossrefPubMedGoogle Scholar
  • 111 Venu RP, Brown RD, Pastika BJ. et al. The buried bumper syndrome: a simple management approach in two patients. Gastrointest Endosc 2002; 56: 582-584
    CrossrefPubMedGoogle Scholar
  • 112 Peck J, Sapp K, Wilsey A. et al. Wire guided cannulation facilitates endoscopic management of buried bumper syndrome: a novel technique. Pediatr Gastroenterol Hepatol Nutr 2019; 22: 86-89
    CrossrefPubMedGoogle Scholar
  • 113 Navarro F, Loflin C, Diegidio P. et al. Herniation through gastrostomy site: Case report. Int J Surg Case Rep 2016; 25: 165-166
    CrossrefPubMedGoogle Scholar
  • 114 Ozutemiz O, Oruc N, Tekin F. et al. Ventral abdominal herniation through PEG site in a child with cystic fibrosis. Endoscopy 2007; 39 (Suppl. 01) E281
    Article in Thieme ConnectPubMedGoogle Scholar
  • 115 Kaplan R, Delegge M. An unusual case of a ventral Richter’s hernia at the site of a previous PEG tube. Dig Dis Sci 2006; 51: 2389-2392
    CrossrefPubMedGoogle Scholar
  • 116 Boldo-Roda E, Peris-Trias A, de Lucia-Penalver GP. et al. Reflections in front of a case of ventral hernia after PEG tube removal. Gastrointest Endosc 2005; 62: 323-324
    CrossrefPubMedGoogle Scholar
  • 117 Chuang CH, Chen CY. Gastric herniation through PEG site. Gastrointest Endosc 2003; 58: 416
    CrossrefPubMedGoogle Scholar
  • 118 Kachare MD, Rossi AJ, Mahpour NY. et al. Incisional hernia after percutaneous endoscopic gastrostomy tube placement: importance of avoiding the linea alba. ACG Case Rep J 2019; 6: e00120
    CrossrefPubMedGoogle Scholar
  • 119 Burney RE, Bryner BS. Safety and long-term outcomes of percutaneous endoscopic gastrostomy in patients with head and neck cancer. Surg Endosc 2015; 29: 3685-3689
    CrossrefPubMedGoogle Scholar
  • 120 Conroy T. The prevention and management of complications associated with established percutaneous gastrostomy tubes in adults: a systematic review. JBI Libr Syst Rev 2009; 7: 1-37
    CrossrefPubMedGoogle Scholar
  • 121 Rosenberger LH, Newhook T, Schirmer B. et al. Late accidental dislodgement of a percutaneous endoscopic gastrostomy tube: an underestimated burden on patients and the health care system. Surg Endosc 2011; 25: 3307-3311
    CrossrefPubMedGoogle Scholar
  • 122 Ridtitid W, Lehman GA, Watkins JL. et al. Short and long-term outcomes from percutaneous endoscopic gastrostomy with jejunal extension. Surg Endosc 2017; 31: 2901-2909
    CrossrefPubMedGoogle Scholar
  • 123 Kulvatunyou N, Zimmerman SA, Sadoun M. et al. Comparing outcomes between “pull” versus “push” percutaneous endoscopic gastrostomy in acute care surgery: under-reported pull percutaneous endoscopic gastrostomy incidence of tube dislodgement. J Surg Res 2018; 232: 56-62
    CrossrefPubMedGoogle Scholar
  • 124 Schrag SP, Sharma R, Jaik NP. et al. Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis 2007; 16: 407-418
    PubMedGoogle Scholar
  • 125 Metussin A, Sia R, Bakar S. et al. Foley catheters as temporary gastrostomy tubes: experience of a nurse-led service. Gastroenterol Nurs 2016; 39: 273-277
    CrossrefPubMedGoogle Scholar
  • 126 Gray C, Grobelna A. Urinary catheters as replacement feeding tubes: a review of clinical effectiveness, cost-effectiveness, and guidelines. May 14, 2019. Ottawa, Ontario: Canadian Agency for Drugs and Technologies in Health. https://www.ncbi.nlm.nih.gov/books/NBK545814/
    Google Scholar
  • 127 Shah J, Sunkara T, Yarlagadda KS. et al. Gastric outlet and duodenal obstruction as a complication of migrated gastrostomy tube: report of two cases and literature review. Gastroenterology Res 2018; 11: 71-74
    CrossrefPubMedGoogle Scholar
  • 128 Rosenberger LH, Guidry CA, Davis JP. et al. Reducing accidental dislodgement of the percutaneous endoscopic gastrostomy: a prospective trial of the "safetybreak" device. Surg Innov 2016; 23: 62-69
    CrossrefPubMedGoogle Scholar
  • 129 Kvello M, Knatten CK, Perminow G. et al. Initial experience with percutaneous endoscopic gastrostomy with T-fastener fixation in pediatric patients. Endosc Int Open 2018; 6: E179-E185
    Article in Thieme ConnectPubMedGoogle Scholar
  • 130 Shah J, Shahidullah A, Richards S. Reducing the unintended dislodgement of gastrostomy tubes in a long-term acute care hospital: A QA/QI pilot study. Gastroenterology Res 2018; 11: 369-373
    CrossrefPubMedGoogle Scholar
  • 131 Okutani D, Kotani K, Makihara S. A case of gastrocolocutaneous fistula as a complication of percutaneous endoscopic gastrostomy. Acta Med Okayama 2008; 62: 135-138
    PubMedGoogle Scholar
  • 132 Lee J, Kim J, Kim HI. et al. Gastrocolocutaneous fistula: an unusual case of gastrostomy tube malfunction with diarrhea. Clin Endosc 2018; 51: 196-200
    CrossrefPubMedGoogle Scholar
  • 133 Ligresti D, Barbuscio I, Granata A. et al. Endoscopic closure of gastrocolocutaneous fistula following percutaneous endoscopic gastrostomy, by OverStitch Endoscopic Suturing System. Endoscopy 2019; 51: E384-E385
    Article in Thieme ConnectPubMedGoogle Scholar
  • 134 Rodrigues-Pinto E, Santos AL, Macedo G. Endoscopic closure of a colocutaneous fistula after placement of percutaneous endoscopic gastrostomy. Endoscopy 2019; DOI: 10.1055/a–1063–6276.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 135 Nunes G, Paiva de Oliveira G, Cruz J. et al. Long-term gastrocolocutaneous fistula after endoscopic gastrostomy: how concerned should we be?. GE Port J Gastroenterol 2019; 26: 441-447
    CrossrefPubMedGoogle Scholar
  • 136 Murino A, Despott EJ, Vaizey C. et al. First report of endoscopic closure of a gastrocolic fistula using an over-the-scope clip system (with video). Gastrointest Endosc 2012; 75: 893 ; discussion 894
    CrossrefPubMedGoogle Scholar
  • 137 Janik TA, Hendrickson RJ, Janik JS. et al. Analysis of factors affecting the spontaneous closure of a gastrocutaneous fistula. J Pediatr Surg 2004; 39: 1197-1199
    CrossrefPubMedGoogle Scholar
  • 138 El-Rifai N, Michaud L, Mention K. et al. Persistence of gastrocutaneous fistula after removal of gastrostomy tubes in children: prevalence and associated factors. Endoscopy 2004; 36: 700-704
    Article in Thieme ConnectPubMedGoogle Scholar
  • 139 Hameed H, Kalim S, Khan YI. Closure of a nonhealing gastrocutanous fistula using argon plasma coagulation and endoscopic hemoclips. Can J Gastroenterol 2009; 23: 217-219
    CrossrefPubMedGoogle Scholar
  • 140 Martinez-Alcala Garcia A, Augustus J, Thakar K. et al. Dual endoscopic technique using through- and over-the-scope clips to close a colo-gastrocutaneous fistula due to a percutaneous gastrostomy tube. Endoscopy 2017; 49: E64-E65
    Article in Thieme ConnectPubMedGoogle Scholar
  • 141 Heinrich H, Gubler C, Valli PV. Over-the-scope-clip closure of long lasting gastrocutaneous fistula after percutaneous endoscopic gastrostomy tube removal in immunocompromised patients: A single center case series. World J Gastrointest Endosc 2017; 9: 85-90
    CrossrefPubMedGoogle Scholar
  • 142 Gay-Chevallier S, Lupu A, Rivory J. et al. Closure of non-healing gastrocutaneous fistula after percutaneous endoscopic gastrostomy by endoscopic submucosal dissection and over-the-scope clip. Endoscopy 2019; 51: E125-E126
    Article in Thieme ConnectPubMedGoogle Scholar
  • 143 Silva HM, Lima R, Pereira F. et al. Endoscopy-assisted suture of gastrocutaneous fistula: a promising approach in pediatric patients. Am J Gastroenterol 2018; 113: 1562-1564
    CrossrefPubMedGoogle Scholar
  • 144 Singhal S, Changela K, Culliford A. et al. Endoscopic closure of persistent gastrocutaneous fistulae, after percutaneous endoscopic gastrostomy (PEG) tube placement, using the over-the-scope-clip system. Therap Adv Gastroenterol 2015; 8: 182-188
    CrossrefPubMedGoogle Scholar
  • 145 Brindley JH, Yip B, Vlachou E. et al. Successful endoscopic closure of a gastrocutaneous fistula using a 'Padlock Clip'. Endoscopy 2016; 48 (Suppl. 01) E115-116
    Article in Thieme ConnectPubMedGoogle Scholar
  • 146 Roveron G, Antonini M, Barbierato M. et al. Clinical practice guidelines for the nursing management of percutaneous endoscopic gastrostomy and jejunostomy (PEG/PEJ) in adult patients: an executive summary. J Wound Ostomy Continence Nurs 2018; 45: 326-334
    CrossrefPubMedGoogle Scholar
  • 147 Clinical Resource Efficiency Support Team (CREST). Guidelines for the management of enteral tube feeding in adults. 2004 https://www.irspen.ie/wp-content/uploads/2014/10/CREST_Guidelines_for_the_management_of_enteral_tube_feeding_in_adults.pdf
    Google Scholar
  • 148 Blumenstein I, Borger D, Loitsch S. et al. A glycerin hydrogel-based wound dressing prevents peristomal infections after percutaneous endoscopic gastrostomy (PEG): a prospective, randomized study. Nutr Clin Pract 2012; 27: 422-425
    CrossrefPubMedGoogle Scholar
  • 149 McClave SA, Jafri NS. Spectrum of morbidity related to bolster placement at time of percutaneous endoscopic gastrostomy: buried bumper syndrome to leakage and peritonitis. Gastrointest Endosc Clin N Am 2007; 17: 731-746
    CrossrefPubMedGoogle Scholar
  • 150 Williams NT. Medication administration through enteral feeding tubes. Am J Health Syst Pharm 2008; 65: 2347-2357
    CrossrefPubMedGoogle Scholar
  • 151 Hossaini Alhashemi S, Ghorbani R, Vazin A. Improving knowledge, attitudes, and practice of nurses in medication administration through enteral feeding tubes by clinical pharmacists: a case-control study. Adv Med Educ Pract 2019; 10: 493-500
    CrossrefPubMedGoogle Scholar
  • 152 McClave SA, DiBaise JK, Mullin GE. et al. ACG clinical guideline: nutrition therapy in the adult hospitalized patient. Am J Gastroenterol 2016; 111: 315-334 ; quiz 335
    CrossrefPubMedGoogle Scholar
  • 153 Siau K, Troth T, Gibson E. et al. How long do percutaneous endoscopic gastrostomy feeding tubes last? A retrospective analysis. Postgrad Med J 2018; 94: 469-474
    CrossrefPubMedGoogle Scholar
  • 154 Villela EL, Sakai P, Almeida MR. et al. Endoscopic gastrostomy replacement tubes: long-term randomized trial with five silicone commercial models. Clin Nutr 2014; 33: 221-225
    CrossrefPubMedGoogle Scholar
  • 155 Pearce CB, Goggin PM, Collett J. et al. The “cut and push” method of percutaneous endoscopic gastrostomy tube removal. Clin Nutr 2000; 19: 133-135
    CrossrefPubMedGoogle Scholar
  • 156 Agha A, AlSaudi D, Furnari M. et al. Feasibility of the cut-and-push method for removing large-caliber soft percutaneous endoscopic gastrostomy devices. Nutr Clin Pract 2013; 28: 490-492
    CrossrefPubMedGoogle Scholar
  • 157 Peacock O, Singh R, Cole A, Speake W. The “cut and push” technique: is it really safe?. BMJ Case Rep 2012; DOI: 10.1136/bcr-2012-006607.
    CrossrefPubMedGoogle Scholar
  • 158 Pratt J, Green S. Removal of percutaneous endoscopic gastrostomy tubes in adults using the “cut and push” method: A systematic review. Clin Nutr ESPEN 2017; 21: 59-65
    CrossrefPubMedGoogle Scholar
  • 159 Kurien M, White S, Simpson G. et al. Managing patients with gastrostomy tubes in the community: can a dedicated enteral feed dietetic service reduce hospital readmissions?. Eur J Clin Nutr 2012; 66: 757-760
    CrossrefPubMedGoogle Scholar
  • 160 Crosby J, Duerksen DR. A prospective study of tube- and feeding-related complications in patients receiving long-term home enteral nutrition. JPEN J Parenter Enteral Nutr 2007; 31: 274-277
    CrossrefPubMedGoogle Scholar
  • 161 Klek S, Hermanowicz A, Dziwiszek G. et al. Home enteral nutrition reduces complications, length of stay, and health care costs: results from a multicenter study. Am J Clin Nutr 2014; 100: 609-615
    CrossrefPubMedGoogle Scholar