Editing Percutaneous endoscopic gastrostomy (section)

==Contraindications==
As with other types of feeding tubes, care must be made to place PEGs into an appropriate population.  The following are contraindications to PEG use:<ref>Gastroenterological endoscopy. Meinhard Classen, G. N. J. Tytgat, Charles J. Lightdale. 2002. {{ISBN|978-1-58890-013-5}}</ref>

===Absolute contraindications===
* Inability to perform an [[esophagogastroduodenoscopy]]
* Uncorrected [[coagulopathy]]
* [[Peritonitis]]
* Untreatable (loculated) massive [[ascites]]
* [[Bowel obstruction]] (unless the PEG is sited to provide drainage)

===Relative contraindications===
* Massive [[ascites]]
* Gastric mucosal abnormalities: large [[gastric varices]], portal hypertensive gastropathy
* Previous [[abdominal surgery]], including previous partial [[gastrectomy]]: increased risk of organs interposed between gastric wall and abdominal wall
* [[Morbid obesity]]: difficulties in locating stomach position by digital indentation of stomach and transillumination
* Gastric wall [[neoplasm]]
* Abdominal wall [[infection]]: increased risk of infection of PEG site
* Intra-abdominal malignancy with peritoneal involvement (tumor seeding into formed channel with subsequent failure)

===In advanced dementia===
The [[American Medical Directors Association]], the [[American Geriatrics Society]] and the [[American Academy of Hospice and Palliative Medicine]] recommend against inserting percutaneous feeding tubes in individuals with advanced dementia and, instead, recommend oral assisted feedings. Artificial nutrition neither prolongs life nor improves its quality in patients with advanced dementia. It may increase the risk of the patient inhaling food, it does not reduce suffering, it may cause fluid overload, diarrhea, abdominal pain and local complications, and it can reduce the amount of human interaction the patient experiences.<ref>Lay summary: {{cite web|url= http://consumerhealthchoices.org/wp-content/uploads/2013/05/ChoosingWiselyFeedingTubeAGS-ER.pdf|title= Feeding tubes for people with Alzheimer's disease: When you need them — and when you don't|publisher= Consumer Reports|access-date= 6 December 2013|archive-url=https://web.archive.org/web/20131212112432/http://consumerhealthchoices.org/wp-content/uploads/2013/05/ChoosingWiselyFeedingTubeAGS-ER.pdf|archive-date=12 December 2013}}
* {{cite web|url= http://www.amda.com/governance/whitepapers/surrogate/clinical.cfm?printPage=1&#Tube_feeding|title= White Paper on Surrogate Decision-Making and Advance Care Planning in Long-Term Care|publisher= American Medical Directors Association -|access-date= 6 December 2013|archive-url= https://web.archive.org/web/20131213225530/http://www.amda.com/governance/whitepapers/surrogate/clinical.cfm?printPage=1&#Tube_feeding|archive-date= 13 December 2013|url-status= dead}}
* {{cite web|url= http://www.americangeriatrics.org/files/documents/feeding.tubes.advanced.dementia.pdf|title= Feeding Tubes in Advanced Dementia Position Statement|last1= Daniel|first1= Kathryn|last2= Rhodes|first2= Ramona|last3= Vitale|first3= Caroline|last4= Shega|first4= Joseph | name-list-style = vanc |date= May 2013|publisher= American Geriatrics Society|access-date= 6 December 2013|archive-url= https://web.archive.org/web/20130921060726/http://www.americangeriatrics.org/files/documents/feeding.tubes.advanced.dementia.pdf|archive-date= 21 September 2013|url-status= dead}}
* {{cite journal|url= http://www.aahpm.org/pdf/06springcoverarticle.pdf|title= Against the Flow: Tube Feeding and Survival in Patients with Dementia|last1= Buff|first1= Daniel D. | name-list-style = vanc |date= Spring 2006|publisher= American Academy of Hospice and Palliative Medicine|journal= AAHPM Bulletin|volume= 7|issue= 1|access-date= 6 December 2013}}</ref>