Percutaneous endoscopic gastrostomy (PEG): a practical approach for long term management

### What you need to know Non-specialists may be involved in care of patients with gastrostomy tubes, in a nursing facility, hospital, or at a patient’s home. In this article, we describe common complications of percutaneous endoscopic gastrostomy to help non-specialists prevent and recognise severe or potentially life-threatening situations and to refer them on for specialist management. Percutaneous endoscopic gastrostomy (PEG) is performed to deliver enteral nutrition directly to the gastrointestinal tract, bypassing the oral cavity.1 Along with alternatives, such as nasal tubes or jejunal feeding, it plays an important role in maintaining nutrition in patients unable to eat orally. Such patients include those with dysphagia, intestinal failure, head or neck cancer, or as treatment in patients with gastrointestinal disease.123 PEG is first line treatment for patients with a functional gastrointestinal tract but inadequate oral nutrient intake who require long term nutritional support (>30 days).45 A gastrostomy tube is inserted percutaneously (through the skin) into the stomach via a small incision performed under local anaesthetic and positioned using an endoscope through the mouth.6 The entry point is known as the PEG …