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Percutaneous endoscopic gastrostomy
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==Indications== Gastrostomy may be indicated in numerous situations, usually those in which normal (or [[nasogastric tube|nasogastric]]) feeding is impossible. The causes for these situations may be neurological (e.g. [[stroke]]), anatomical (e.g. [[cleft lip and palate]] during the process of correction) or other (e.g. [[radiation therapy]] for tumors in head & neck region).{{citation needed|date=January 2022}} In certain situations where normal or nasogastric feeding is not possible, gastrostomy may be of no clinical benefit. In advanced [[dementia]], studies show that PEG placement does not in fact prolong life.<ref>{{cite journal |vauthors=Murphy LM, Lipman TO |title=Percutaneous endoscopic gastrostomy does not prolong survival in patients with dementia |journal=Arch. Intern. Med. |volume=163 |issue=11 |pages=1351β3 |year=2003 |pmid=12796072 |doi=10.1001/archinte.163.11.1351|citeseerx=10.1.1.610.6648 }}</ref> Instead, oral [[assisted feeding]] is preferable.<ref>{{Citation |author1 = AMDA β The Society for Post-Acute and Long-Term Care Medicine |author1-link = AMDA β The Society for Post-Acute and Long-Term Care Medicine |date = February 2014 |title = Ten Things Physicians and Patients Should Question |publisher = AMDA β The Society for Post-Acute and Long-Term Care Medicine |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/amda/ |access-date = 20 April 2015}}.</ref> Quality improvement protocols have been developed with the aim of reducing the number of non-beneficial gastrostomies in patients with dementia.<ref>{{cite journal |vauthors=Monteleoni C, Clark E |title=Using rapid-cycle quality improvement methodology to reduce feeding tubes in patients with advanced dementia: before and after study |journal=BMJ |volume=329 |issue=7464 |pages=491β4 |year=2004 |pmid=15331474 |doi=10.1136/bmj.329.7464.491 |pmc=515202}}</ref> A gastrostomy can be placed to decompress the stomach contents in a patient with a malignant bowel obstruction. This is referred to as a "venting PEG" and is placed to prevent and manage nausea and vomiting. A gastrostomy can also be used to treat [[volvulus]] of the stomach, where the stomach twists along one of its axes. The tube (or multiple tubes) is used for gastropexy, or adhering the stomach to the abdominal wall, preventing twisting of the stomach.<ref name=Gauderer01/> A PEG tube can be used in providing gastric or post-surgical drainage.<ref>Gail Waldby, "PEG-J Gastrostomy drainage jejunal feeding tubes" {{cite web |url=http://surgnurseslinks.com/caluso.htm |title=Untitled Document |access-date=2010-10-16 |url-status=dead |archive-url=https://web.archive.org/web/20110716165120/http://surgnurseslinks.com/caluso.htm |archive-date=2011-07-16 }}</ref>
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