American Society for Gastrointestinal Endoscopy guideline on gastrostomy feeding tubes: summary and recommendations

ASGE Standards of Practice Committee; Divyanshoo Rai Kohli; Wasif M Abidi; Natalie Cosgrove; Jorge D Machicado; Madhav Desai; Nauzer Forbes; Neil B Marya; Nikhil R Thiruvengadam; Nirav C Thosani; Omeed Alipour; Saowanee Ngamruengphong; Sherif E Elhanafi; Sunil G Sheth; Wenly Ruan; John C Fang; Stephen A McClave; Rodrick C Zvavanjanja; Amir Y Kamel; Bashar J Qumseya

doi:10.1016/j.gie.2024.08.044

American Society for Gastrointestinal Endoscopy guideline on gastrostomy feeding tubes: summary and recommendations

Gastrointest Endosc. 2025 Jan;101(1):25-35. doi: 10.1016/j.gie.2024.08.044. Epub 2024 Nov 7.

Authors

ASGE Standards of Practice Committee; Divyanshoo Rai Kohli¹, Wasif M Abidi², Natalie Cosgrove³, Jorge D Machicado⁴, Madhav Desai⁵, Nauzer Forbes⁶, Neil B Marya⁷, Nikhil R Thiruvengadam⁸, Nirav C Thosani⁵, Omeed Alipour⁹, Saowanee Ngamruengphong¹⁰, Sherif E Elhanafi¹¹, Sunil G Sheth¹², Wenly Ruan¹³, John C Fang¹⁴, Stephen A McClave¹⁵, Rodrick C Zvavanjanja¹⁶, Amir Y Kamel¹⁷, Bashar J Qumseya¹⁸

Affiliations

¹ Pancreas and Liver Clinic, Providence Sacred Medical Center, Elson Floyd School of Medicine, Washington State University, Spokane, Washington, USA.
² Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
³ Center for Interventional Endoscopy AdventHealth, Orlando, Florida, USA.
⁴ Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
⁵ Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA.
⁶ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁷ Division of Gastroenterology, UMass Chan Medical School, Worcester, Massachusetts, USA.
⁸ Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA.
⁹ Division of Gastroenterology, University of Washington Medical Center, Seattle, Washington, USA.
¹⁰ Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.
¹¹ Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
¹² Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
¹³ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
¹⁴ Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, Utah, USA.
¹⁵ Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
¹⁶ Department of Diagnostic and Interventional Radiology at UTHealth, McGovern Medical School, Houston, Texas, USA.
¹⁷ 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.
¹⁸ Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA.

PMID: 39520459
DOI: 10.1016/j.gie.2024.08.044

Abstract

This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for strategies to manage endoscopically placed gastrostomy tubes. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework. The guideline addresses the utility of PEG versus interventional radiology-guided gastrostomy (IR-G), need for withholding antiplatelet and anticoagulant medications before PEG tube placement, appropriate timing to initiate tube feeding after PEG, and selection of the appropriate technique of gastrostomy in patients with malignant dysphagia. In patients needing enteral access, the ASGE suggests PEG as the preferred technique for initial gastrotomy over IR-G. The ASGE recommends that tube feeding can be safely started within 4 hours of gastrostomy. The ASGE suggests that PEG can be performed without withholding antiplatelet medications. The ASGE suggests that the periprocedural management of anticoagulants should be based on a multidisciplinary discussion regarding the risk of bleeding versus cardiovascular events. In patients with malignant dysphagia, either transoral "pull" PEG or direct PEG can be performed for initial enteral access.

Publication types

Practice Guideline

MeSH terms

Anticoagulants / administration & dosage
Anticoagulants / therapeutic use
Deglutition Disorders / therapy
Endoscopy, Gastrointestinal / methods
Endoscopy, Gastrointestinal / standards
Enteral Nutrition* / methods
Gastrostomy* / methods
Humans
Platelet Aggregation Inhibitors / administration & dosage
Platelet Aggregation Inhibitors / therapeutic use

Substances

Anticoagulants
Platelet Aggregation Inhibitors