key: cord-0803514-88sgnqxq
authors: Goyal, Hemant; Perisetti, Abhilash; Tharian, Benjamin
title: Percutaneous Endoscopic Gastrostomy tube placement in COVID‐19 patients: Multidisciplinary approach
date: 2020-11-17
journal: Dig Endosc
DOI: 10.1111/den.13873
sha: 2c4442247e57ebb61cd6230f97f30eba276fdf9b
doc_id: 803514
cord_uid: 88sgnqxq

Percutaneous endoscopic gastrostomy (PEG-tube) placement is a relatively safe procedure for enteral nutrition in appropriately selected patients. Gastroenterologists are sought for PEG-tube placements in COVID-19 patients with vent-dependent respiratory failure. Though PEG-tube placement along with tracheostomy may expedite discharge planning, there are unique challenges for endoscopy staff because of the potential for viral transmission 1 . There is no gastroenterological society recommendation for a maximum duration of nasogastric (NG) or oro-gastric (OG) tube in critically ill patients. However, the general consensus is to wait about 4 weeks because of increased risk of complications beyond this duration.

Percutaneous endoscopic gastrostomy (PEG-tube) placement is a relatively safe procedure for enteral nutrition in appropriately selected patients. Gastroenterologists are sought for PEG-tube placements in COVID-19 patients with vent-dependent respiratory failure. Although PEG-tube placement along with tracheostomy may expedite discharge planning, there are unique challenges for endoscopy staff because of the potential for viral transmission. 1 There is no gastroenterological society recommendation for a maximum duration of nasogastric (NG) or oro-gastric (OG) tube in critically ill patients. However, the general consensus is to wait about 4 weeks because of increased risk of complications beyond this duration. 2 If a PEG-tube is deemed necessary, a multidisciplinary discussion (patient's family, primary, procedural, and palliative care teams) should be held to discuss risks and benefits of the procedure, nutrition goals, and overall prognosis ( Table 1) . Guidelines from the COVID-19 tracheostomy task force recommend waiting for at least 21 days before performing a tracheostomy. 3 A similar window period of 3-4 weeks for PEG-tube placement can be considered to avoid transmission. Patients' transport should be minimized to reduce the transmission risk; however, barrier methods (plastic patient-isolation drapes) should be used if deemed necessary. A small size hole (about 6 inches) can be made in the drape to access expected site of PEGtube placement. All patients should receive prophylactic antibiotics as per guidelines. The "pull-technique" should be used while minimizing suctioning in addition to practicing "cluster care" 4 while performing other procedures/imaging needed for the patient (PEGtube placement immediately before or after tracheostomy to minimize transport and exposure risk) ( Table 2 ). In short, devising institutional guidelines regarding appropriate patient selection, optimizing the timing of PEG-tube placement along with tracheostomy if needed, while observing a multidisciplinary team approach, and minimizing endoscopic personnel during the procedure can decrease the exposure risk and improve patient care as well as free-up intensive care unit (ICU) resources.

Authors declare no conflicts of interest for this article. 

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