Gastrostomy (PEG or Open)

Procedure Snapshot

• Indication: Long-term enteral feeding with functional stomach.
• Expected duration: ___
• Special instruments: PEG kit or 0 silk stay sutures, Foley/PEG tube.

Step Workflow

PEG

1. Endoscopic visualization of transillumination point.
2. Small stab incision in LUQ; introduce needle under scope view.
3. Snare wire and pull tube through mouth→abdomen.

Open

1. Small upper-midline incision; identify stomach.
2. Purse-string suture; insert tube and tie.
3. Fix stomach to abdominal wall.

Key Pimp Questions

• Q: When PEG contraindicated?
  A: Obstructed pharynx/esophagus, massive ascites.
• Q: Common complication?
  A: Peristomal infection ___ (PMID 32021489).

Critical Anatomy

• Landmarks: Stomach anterior wall ~2 cm below costal margin.
• Danger zones: Colon, transverse mesocolon, liver.

Informed Consent Highlights

• Risks: Bleeding __, infection __, leak ___.

Post-op Considerations

• Use after 12–24 h if no leak.
• Daily rotation/flush.

References

• Chassin’s, Feeding Access chapter.
• Clinical Scenarios, Upper GI.
• Larson 2020 (PMID 32021489).