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
,
 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

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

Publication Date:
21 December 2020 (online)

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

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