为推进肿瘤患者经皮内镜下胃造瘘术(PEG)及经皮内镜下胃-空肠造瘘术(PEG-J)的规范化应用,中国抗癌协会肿瘤营养专业委员会肿瘤营养通路协作组基于循证证据与临床实践,制定本团体标准。本标准系统明确了PEG/PEG-J的适应证与禁忌证;在技术操作层面,提出了包括患者全身状况、胃肠功能及镇静风险评估在内的术前综合评估要求;逐步描述了pull法和introducer法PEG的置管流程与空肠延长管放置的操作要点。在管理体系上,涵盖了术后早期喂养启动、规范化管路维护(冲管、换药、固定与更换)以及并发症的防治策略,重点对出血、造口感染、管周渗漏、包埋综合征、脏器损伤等常见并发症提供了分级预防与具体处置指引。此外,标准亦明确了PEG管移除的临床指征、综合评估方法及内镜下与非内镜下移除的操作规范。本文件旨在构建覆盖评估、操作、管理与并发症处理的全流程标准化方案,为各级临床机构提供具体、可行的技术执行依据。
Abstract
To advance the standardized application of percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic gastrojejunostomy (PEG-J) in cancer patients, the Collaborative Group on Oncology Nutrition Access under the Chinese Society of Nutritional Oncology has developed this group standard based on evidence and clinical practice. This standard defines the indications and contraindications for PEG/PEG-J. At the technical level, it outlines comprehensive preoperative assessment requirements, including overall condition, gastrointestinal function, and sedation risk evaluation. It provides a step-by-step description of the procedural details for both the pull and introducer PEG methods, as well as the placement of jejunal extension tubes. Regarding management, it covers the initiation of early postoperative feeding, standardized tube care (flushing, dressing change, fixation, and replacement), and strategies for complication prevention and management. Special emphasis is placed on graded prevention and specific management guidelines for common complications such as bleeding, stoma infection, peritubal leakage, buried bumper syndrome, and organ injury. The standard clarifies the clinical indications for PEG tube removal, the comprehensive assessment methodology, and the operational protocols for both endoscopic and non-endoscopic removal. This document aims to establish a complete, standardized protocol encompassing assessment, operation, management, and complication handling, providing concrete and actionable technical guidance for clinical institutions at all levels.
关键词
经皮内镜下胃造瘘术 /
经皮内镜下胃-空肠造瘘术 /
肿瘤营养 /
操作规范 /
并发症
Key words
Percutaneous endoscopic gastrostomy /
Percutaneous endoscopic gastrojejunostomy /
Oncology nutrition /
Operational standards /
Complications
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] MICIC D, MARTIN J A, FANG J. AGA clinical practice update on endoscopic enteral access: commentary [J]. Gastroenterology,2025,168(1):164-168.
[2] MAURIZIO M, JANN A, PATRICK B, et al. ESPEN practical guideline: clinical nutrition in cancer [J]. J Clin Nutr,2021,40(5):2898-2913.
[3] AUREO AUGUSTO DE ALMEIDA D, DIOGO TURIANI HOURNEAUX D M, IGOR BRAGA R, et al. Propofol vs traditional sedatives for sedation in endoscopy: a systematic review and meta-analysis [J]. World J Gastrointest Endosc,2019,11(12):573-588.
[4] EMMANUEL T, ANDRÉ V G, ASUNCION B, et al. Enteral access in adults [J]. J Clin Nutr,2014,34(3):350-358.
[5] KOHLI D R, ABIDI W M, COSGROVE N, et al. American society for gastrointestinal endoscopy guideline on gastrostomy feeding tubes: summary and recommendations [J]. Gastrointest Endosc,2025,101(1):25-35.
[6] IYER K R, CRAWLEY T C. Complications of enteral access [J]. Gastrointest Endosc Clin N Am,2007,17(4):717-729.
[7] JAFRI N S, MAHID S S, MINOR K S, et al. Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy [J]. Aliment Pharmacol Ther,2007,25(6):647-656.
[8] GAUDERER M W, PONSKY J L, IZANT R J,et al. Gastrostomy without laparotomy: a percutaneous endoscopic technique [J]. J Pediatr Surg,1980,15(6):872-875.
[9] WATANABE J, KOTANI K. Early versus delayed feeding after percutaneous endoscopic gastrostomy placement in children: a meta-analysis [J]. Children (Basel, Switzerland), 2020, 7(9),124.
[10] TUNA M, LATIFI R, EL-MENYAR A, et al. Gastrointestinal tract access for enteral nutrition in critically ill and trauma patients: indications, techniques, and complications [J]. European journal of trauma and emergency surgery : official publication of the European Trauma Society,2013,39(3):235-242.
[11] VEITCH A M, VANBIERVLIET G, GERSHLICK A H, et al. Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines [J]. Endoscopy, 2016, 48(4): c1.
[12] FUGAZZA A, CAPOGRECO A, CAPPELLO A, et al. Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques [J]. World J Gastrointest Endosc,2022,14(5):250-266.
[13] HUCL T, SPICAK J. Complications of percutaneous endoscopic gastrostomy [J]. Best Pract Res Clin Gastroenterol,2016,30(5):769-781.
[14] LIPP A, LUSARDI G. Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy [J]. Cochrane Database Syst Rev, 2006, (4): Cd005571.
[15] BOEYKENS K, DUYSBURGH I. Prevention and management of major complications in percutaneous endoscopic gastrostomy [J]. BMJ Open Gastroenterol, 2021, 8(1):e000628.
[16] BOEYKENS K, DUYSBURGH I, VERLINDEN W. Prevention and management of minor complications in percutaneous endoscopic gastrostomy [J]. BMJ Open Gastroenterol, 2022, 9(1): e000975.
[17] LIN H S, IBRAHIM H Z, KHENG J W, et al. Percutaneous endoscopic gastrostomy: strategies for prevention and management of complications [J]. Laryngoscope,2001,111(10):1847-1852.
[18] MCCLAVE S A, CHANG W K. Complications of enteral access [J]. Gastrointest Endosc,2003,58(5):739-751.
[19] TIANKANON K, ANIWAN S, KARUEHARDSUWAN J, et al. Factors affecting late complications of percutaneous endoscopic gastrostomy tube replacement [J]. Clin Nutr ESPEN,2022,49:378-384.
[20] TAE C H, LEE J Y, JOO M K, et al. Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy [J]. Gut Liver,2024,18(1):10-26.
[21] LYNCH C R, FANG J C J P G. Prevention and management of complications of percutaneous endoscopic gastrostomy (PEG) tubes [J]. Pract Gastroenterol,2004,28(11):66-76.
[22] TSANG T K, EATON D, FALCONIO M A. Percutaneous ostomy dilation: a technique for dilating the closed percutaneous endoscopic gastrostomy sites and reinserting gastrostomies [J]. Gastrointest Endosc,1989,35(4):336-337.
[23] BENNELL J. Buried bumper syndrome: do we have enough evidence? [J]. Br J Community Nurs, 2018, 23(Sup7): S28-S30.
[24] DELEGGE M, DELEGGE R, BRADY C. External bolster placement after percutaneous endoscopic gastrostomy tube insertion: is looser better? [J]. JPEN J Parenter Enteral Nutr,2006,30(1):16-20.
[25] BANNISTER M. Insertion of percutaneous endoscopic gastrostomy by head and neck surgeons: systematic review [J]. Br J Oral Maxillofac Surg,2016,54(2):132-134.
[26] KACHARE M D, ROSSI A J, MAHPOUR N Y, et al. Incisional hernia after percutaneous endoscopic gastrostomy tube placement: importance of avoiding the linea alba [J].ACG Case Rep J, 2019, 6(7): e00120.
[27] ROCHE V. Percutaneous endoscopic gastrostomy. Clinical care of PEG tubes in older adults [J]. Geriatrics,2003,58(11):22-26,28-29.
[28] NUNES G, MEIRA T, PATITA M, et al. Feeding tube transparietal thickness-a promising anthropometric parameter for nutritional assessment of endoscopic gastrostomy fed patients [J]. Clin Nutr ESPEN,2019,29:224-230.
[29] CEDERHOLM T, BARAZZONI R, AUSTIN P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition [J]. Clin Nutr,2017,36(1):49-64.
[30] SUITER D M, LEDER S B. Clinical utility of the 3-ounce water swallow test [J]. Dysphagia,2008,23(3):244-250.
[31] BELAFSKY P C, MOUADEB D A, REES C J, et al. Validity and reliability of the eating assessment tool (EAT-10) [J].Ann Otol Rhinol Laryngol,2008,117(12):919-924.
[32] ZENG H, JIA X, TIAN Q, et al. Reliability and validity of the chinese mandarin version of the 10-item eating assessment tool in community-dwelling older adults [J]. J Speech Lang Hear Res,2025,68(6):2825-2835.
[33] TRAPL M, ENDERLE P, NOWOTNY M, et al. Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen [J]. Stroke,2007,38(11):2948-2952.
[34] CLAVÉ P, ARREOLA V, ROMEA M, et al. Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration [J]. Clin Nutr,2008,27(6):806-815.
[35] LIN Y, WAN G, WU H, et al. The sensitivity and specificity of the modified volume-viscosity swallow test for dysphagia screening among neurological patients [J].Front Neurol,2022,13:961893.
[36] CHEN Y C, LI C I, TSOU Y A, et al. Repetitive saliva swallowing test: performance in aspiration prediction [J]. J Formos Med Assoc, 2025: S0929-6646(25)00389-4.
[37] LABEIT B, AHRING S, BOEHMER M, et al. Comparison of simultaneous swallowing endoscopy and videofluoroscopy in neurogenic dysphagia [J].J Am Med Dir Assoc,2022,23(8):1360-1366.
[38] PRIKLADNICKI A, SANTANA M G, CARDOSO M C. Protocols and assessment procedures in fiberoptic endoscopic evaluation of swallowing: an updated systematic review [J].Braz J Otorhinolaryngol,2022,88(3):445-470.
[39] LÖSER C, ASCHL G, HÉBUTERNE X, et al. ESPEN guidelines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG) [J]. Clin Nutr,2005,24(5):848-861.
[40] PEACOCK O, SINGH R, COLE A, et al. The 'cut and push' technique: is it really safe? [J].BMJ Case Rep, 2012, 2012:bcr2012006607.
基金
福建省临床重点专科建设项目(2023);泉州市高层次人才团队项目(2024CT014)
PDF(2733 KB)
