PEG Placement Technique

q The endoscope and snared suture are withdrawn through the mouth r The suture is tied to the PEG tube

s The assistant pulls gently but briskly on the other end of the suture

s The assistant pulls gently but briskly on the other end of the suture t The PEG tube is stabilized as it enters the mouth

u After the tube has been pulled into place, an external bolster is applied

v View of the internal bumper on the stomach wall

w The tube is tightened to eliminate slack x Finally the PEG is checked endoscopi-

cally for correct placement

Fig. 4.34 Inserting a duodenal tube through a PEG tube already in place a The endoscope is advanced to the PEG tube, and the duodenal tube is introduced

Fig. 4.34 Inserting a duodenal tube through a PEG tube already in place a The endoscope is advanced to the PEG tube, and the duodenal tube is introduced

b The duodenal tube is grasped with a forceps

c The endoscope is advanced distally with the grasped duodenal tube w

d The endoscope is advanced to the py- e The endoscope is passed deep into the lorus duodenum, carrying the duodenal tube with it

f View of the tube positioned in the duodenum

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