Dave Sawbridge Gastroenterologist Mater Private Cork Contents Practicalities of PEGPEGJPEJ insertion Complications buried bumper infectiongranulation PEGPEGJPEJ Insertion who and when ID: 1011391
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1. Percutaneous Tube Insertion Troubleshooting – Medical aspectsDave SawbridgeGastroenterologistMater Private Cork
2. ContentsPracticalities of PEG/PEG-J/PEJ insertionComplications – buried bumper, infection/granulation
3. PEG/PEG-J/PEJ Insertion – who and when?Supplemental nutrition required via ET for >1/12 If post-pyloric feeding needed – PEG-J or PEJStableConsent/dual consent? Access for pull through vs RIG/PEXACTKey contraindications: severe ascites, interposed organs, peritoneal carcinomatosis, anorexia nervosa, limited life expectancy
4. PEG/PEG-J/PEJ Insertion - How
5. Jejunal extensions/jejunostomyPEG-JJejunostomy
6. PEG/PEG-J/PEJ Insertion – risks/benefitsBenefitsReduced risk of dislodgementSimplified feed/medication managementOption/reliable post-pyloric feeding/medication deliveryReduced risk of aspiration of feedMore sightly/more easily to concealMore easy to access
7. PEG/PEG-J/PEJ Insertion - complicationsEarly - serious risks 1-4%PainDislodgementInfection/peritonitisPerforationLate - (mostly) preventable by good careburied bumperDisplacement – bumper, extensionBlockageIntersussception/gastric outlet obstructionInfectionLeakageWear and tear – replace balloon systems every 6 months
8. Buried bumperRisk Mitigation – advance and rotate tube daily 2-3cm during cleaning PEG-J – advance daily without rotationPush under endoscopic guidanceSnare manipulationRat-toothed forcepsVariety of pushing devicesMini-laparotomy
9. PEG leaksWhat is leaking – pus/gastric contents/food?Inspect tubing for damageCan you inject/aspirate? If so any leak?Tube lies loosely in tract? – is there any option to leave tract to heal up with smaller place holder?Overgranulation/superficial infection? Treat underlying infection –swabHydrocolloid dressings if gastric contents +/- sucralfate paste1% hydrocortisone cream +/-Silver nitrate/laser cauterySecure external fixatorReduce tensionReduce manipulation