What are the relative contraindications for percutaneous endoscopic gastrostomy (PEG) tube placement?

Updated: Dec 13, 2018
  • Author: Gaurav Arora, MD, MS; Chief Editor: Danny A Sherwinter, MD  more...
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Answer

Relative contraindications for PEG tube placement include the following:

  • Presence of oropharyngeal or esophageal malignancy (potential risk of seeding of the PEG tract)
  • Hepatomegaly
  • Esophageal malignancy that will require the use of the stomach as a conduit for reconstruction following definitive esophageal resection 
  • Portal hypertension with gastric varices
  • History of prior abdominal surgical procedures (possible presence of adhesions and bowel interposition)
  • Peritoneal dialysis
  • History of partial gastrectomy

Opinions have varied as to whether placement of a ventriculoperitoneal shunt constitutes a contraindication for PEG. A systematic review by Oterdoom et al concluded that placement of such a shunt in conjunction with a PEG tube was associated with a high but acceptable shunt complication rate and that shunt insertion therefore should not be considered a contraindication to PEG. [12] They suggested that the PEG tube should be placed after the ventriculoperitoneal shunt but did not conclusively establish an optimal interval.


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