Perkütan Endoskopik Gastrostomi (PEG)
Özet
Perkütan Endoskopik Gastrostomi (PEG), oral beslenmesi yetersiz olan ve 4-6 hafta süreyle enteral beslenme desteğine ihtiyaç duyan, fonksiyonel gastrointestinal sisteme sahip hastalarda uluslararası kılavuzlar tarafından öncelikli olarak önerilen, düşük maliyetli ve minimal invaziv bir yöntemdir. İlk kez 1980 yılında uygulanan bu endoskopik işlem, özellikle serebrovasküler hastalıklar, demans, Parkinson gibi nörolojik rahatsızlıklar ile baş-boyun kanserleri ve yoğun bakım hastalarında malnütrisyon gelişimini önlemek ve hastanın yaşam kalitesini artırmak amacıyla yaygın şekilde tercih edilmektedir. Ciddi pıhtılaşma bozuklukları, hemodinamik instabilite, peritonit ve sepsis gibi durumlarda kesinlikle uygulanmaması gereken bu prosedür, genel olarak güvenli kabul edilse de belirli majör ve minör komplikasyon riskleri barındırmaktadır. Klinik süreçte masif kanamalar, ölümcül seyredebilen aspirasyon pnömonisi, bağırsak perforasyonu gibi iç organ yaralanmaları, nekrotizan fasiit, tümör ekilimi ve gömülü tampon sendromu ciddi majör komplikasyonlar arasında yer alır. Bununla birlikte, stoma sızıntısı, lokal yara enfeksiyonları, tüpün tıkanması veya yerinden çıkması ile granülom oluşumu gibi minör sorunlar da sıklıkla gözlenmektedir. Başarılı bir PEG uygulaması için işlem öncesinde hastanın en az 8 saat aç kalması, profilaktik antibiyotik alması ve pıhtılaşma değerlerinin normal sınırlarda olması gerekir. En sık kullanılan "çekme" tekniğinin yanı sıra, işlem sonrasında tüpün düzenli yıkanması, stoma bakımı ve beslenme esnasında hastanın 30-45 derece açıyla oturtulması kritik önem taşır.
Percutaneous Endoscopic Gastrostomy (PEG) is a highly effective, cost-efficient, and minimally invasive enteral feeding pathway recommended by international guidelines for patients with a functional gastrointestinal tract who require nutritional support for more than four to six weeks. Introduced in 1980, this endoscopic procedure is widely indicated for individuals suffering from neurological dysphagia, such as stroke, dementia, and Parkinson's disease, as well as head and neck malignancies, head traumas, and critical illnesses in intensive care units to systematically prevent severe malnutrition and optimize overall quality of life. Although PEG is considered a reliable intervention, it is strictly contraindicated in cases of severe uncorrectable coagulopathy, hemodynamic instability, peritonitis, and active sepsis. The procedure carries inherent risks of major complications, including massive gastrointestinal bleeding, life-threatening aspiration pneumonia, accidental visceral organ perforation, necrotizing fasciitis, tumor seeding along the tract, and buried bumper syndrome. Additionally, minor complications such as localized wound infections, peristomal leakage, tube displacement, occlusion, and granulation tissue formation are frequently encountered in clinical practice. Pre-procedural preparation demands an explicit eight-hour fasting window, prophylactic antibiotic treatment, and coagulation screening. While the "pull" method remains the global standard for insertion, meticulously executed post-procedural care—including scheduled tube flushing, stoma evaluation, and maintaining a 30-to-45-degree patient elevation during feeding—is critical to preventing adverse outcomes.
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