American Society for Gastrointestinal Endoscopy guideline on gastrostomy feeding tubes: methodology and review of evidence
Divyanshoo Rai Kohli, MD,
Natalie Cosgrove, MD,
Wasif M. Abidi, MD, PhD,
Jorge D. Machicado, MD, MPH,
Madhav Desai, MD, MPH,
Nauzer Forbes, MD, MSc,
Neil B. Marya, MD,
Nikhil R. Thiruvengadam, MD,
Nirav C. Thosani, MD, MHA,
Omeed Alipour, MD,
Saowanee Ngamruengphong, MD,
Sherif E. Elhanafi, MD,
Sunil G. Sheth, MD,
Wenly Ruan, MD,
John C. Fang, MD,
Stephen A. McClave, MD,
Rodrick C. Zvavanjanja, MD, MSc, FRCR(UK), FSIR, DABR(DR/VIR),
Dhruvil K. Radadiya, MBBS,
Amir Y. Kamel, PharmD, BCNSP,
Bashar J. Qumseya, MD, MPH
Affiliations
Divyanshoo Rai Kohli, MD
Pancreas and Liver Clinic, Providence Sacred Medical Center, Elson Floyd School of Medicine, Washington State University, Spokane, Washington, USA
Natalie Cosgrove, MD
Center for Interventional Endoscopy AdventHealth, Orlando, Florida, USA
Wasif M. Abidi, MD, PhD
Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
Jorge D. Machicado, MD, MPH
Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
Madhav Desai, MD, MPH
Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
Nauzer Forbes, MD, MSc
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Neil B. Marya, MD
Division of Gastroenterology, UMass Chan Medical School, Worcester, Massachusetts, USA
Nikhil R. Thiruvengadam, MD
Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
Nirav C. Thosani, MD, MHA
Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
Omeed Alipour, MD
Division of Gastroenterology, University of Washington Medical Center, Seattle, Washington, USA
Saowanee Ngamruengphong, MD
Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
Sherif E. Elhanafi, MD
Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
Sunil G. Sheth, MD
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
Wenly Ruan, MD
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
John C. Fang, MD
Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, Utah, USA
Stephen A. McClave, MD
Department of Medicine, University of Louisville, Louisville, Kentucky, USA
Rodrick C. Zvavanjanja, MD, MSc, FRCR(UK), FSIR, DABR(DR/VIR)
Department of Diagnostic and Interventional Radiology at UTHealth, McGovern Medical School, Houston, Texas, USA
Dhruvil K. Radadiya, MBBS
Department of Gastroenterology, Hepatology and Motility, University of Kansas, Kansas City, Kansas USA
Amir Y. Kamel, PharmD, BCNSP
Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA; Department of Pharmacy, UF Health Shands Hospital, University of Florida College of Pharmacy, Gainesville, Florida, USA
Bashar J. Qumseya, MD, MPH
Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA
This article from the American Society for Gastrointestinal Endoscopy (ASGE) provides a full description of the methodology used to inform the final guidance outlined in the accompanying summary and recommendations article for strategies to manage endoscopically placed gastrostomy tubes. This article was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and specifically addresses the utility of PEG versus interventional radiology–guided gastrostomy (IR-G), the need for withholding antiplatelet and anticoagulant medications, appropriate timing to initiate tube feedings, and appropriate selection of the gastrostomy technique in patients with malignant dysphagia. In patients needing enteral access, the ASGE suggests PEG as the preferred technique for initial gastrostomy over IR-G. The ASGE recommends that tube feeding can be safely started within 4 hours of the gastrostomy without the need for an intentional delay. The ASGE suggests that a PEG can be performed without the need to withhold antiplatelet medications. In patients on anticoagulants who need to undergo PEG placement, the ASGE suggests that the periprocedural management of anticoagulants should be based on a multidisciplinary discussion with the patient regarding the risk of bleeding versus cardiovascular adverse events. In patients with malignant dysphagia, either transoral “Pull” PEG or transcutaneous “Direct” PEG can be performed for initial enteral access.
