Percutaneous Endoscopic Gastrostomy (PEG)- Practical Application in Neurology

Overview

PEG is a relatively new method with low invasiveness which resolves several aspects of thepatients nutrition. In neurological patients it still seeks more closely defined indications in acuteas well as in chronic conditions. It avoids the majority of complications of nasogastric tubes(inflammations, oesophageal strictures, irritation by the tube due to the patient’s unrest, poorcooperation of the patient in particular during speech rehabilitation). The procedure andlong-term introduction of PEG are associated with minor complications. In the authors’ groupof 40 patients with PEG (2 patients with ALS, 6 patients after craniocerebral injury, one aftercerebral hypoxia and 31 patients after a cerebrovascular attack) complications developed in27.5% and were only mild. Despite the fact that in all instances a serious neurological diseasewas involved 20% patients started to swallow spontaneously and the tube was removed. 62.5%patients died (all with a tube) and 17.5%survive (they still have an inserted PEG).An indicationfor the use of PEG in neurology are in addition to basic impairment of swallowing alsoconcurrent inadequate nutrition, unrest (with pulling of the NGS), impaired speech (speechrehabilitation) tracheostomy, long-term perspective of tube feeding, easier nursing of a patientwith introduced PEG.

Key words:
dysphagia - nasogastric tube - percutaneous endoscopic gastrostomy.