[Percutaneous endoscopic gastrostomy]

Probes for the percutaneous endoscopic gastrostomy (PEG) are placed by pull-through methods or by direct puncture of the stomach. Depending on the length of the interior branch of the probe, gastral or (duodeno-) jejunal feeding is possible; the latter may also be achieved by direct percutaneous endoscopic jejunostomy (PEJ). Small calibre endoscopes can be introduced via large-bore PEG probes; after the extraction of such a probe the resulting fistulous tract itself may also be used für percutaneous endoscopy by using pediatric endoscopes. The usual external fixation of the probes with compresses fixed by sticking plaster creates a humid chamber favouring the growth of bacteria. This can be avoided by an open well-aired fixation using a ring. Indications for the probes are prolonged enteral feeding in patients enable to swallow or to consume adequate nutrition orally, decompression in gastrointestinal obstruction, instillation of percutaneously drained bile and percutaneous endoscopy, e.g. for repeated retrograde laser application as a palliative treatment in patients with tumour obstruction of the oesophagus. Complications due to PEG/PEJ probes are relatively rare; severe are aspiration in cases of gastro-oesophageal reflux and peritonitis.