This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for strategies to manage endoscopically placed gastrostomy tubes. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework. The guideline addresses the utility of PEG versus interventional radiology–guided gastrostomy (IR-G), need for withholding antiplatelet and anticoagulant medications before PEG tube placement, appropriate timing to initiate tube feeding after PEG, and selection of the appropriate technique of gastrostomy in patients with malignant dysphagia. In patients needing enteral access, the ASGE suggests PEG as the preferred technique for initial gastrotomy over IR-G. The ASGE recommends that tube feeding can be safely started within 4 hours of gastrostomy. The ASGE suggests that PEG can be performed without withholding antiplatelet medications. The ASGE suggests that the periprocedural management of anticoagulants should be based on a multidisciplinary discussion regarding the risk of bleeding versus cardiovascular events. In patients with malignant dysphagia, either transoral “pull” PEG or direct PEG can be performed for initial enteral access.

中文翻译：

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美国胃肠内镜学会胃造瘘饲管指南：总结和建议


美国胃肠内窥镜学会 （ASGE） 的临床实践指南为管理内窥镜放置的胃造瘘管的策略提供了一种循证方法。本文件是使用建议分级评估、制定和评价框架编写的。该指南讨论了 PEG 与介入放射学引导胃造瘘术 （IR-G） 的效用、在放置 PEG 管前停用抗血小板和抗凝药物的必要性、PEG 后开始管饲的适当时机，以及为恶性吞咽困难患者选择合适的胃造瘘术技术。对于需要肠内通路的患者，ASGE 建议 PEG 作为初始胃切开术的首选技术，而不是 IR-G。ASGE 建议在胃造口术后 4 小时内可以安全地开始管饲。ASGE 表明，可以在不停用抗血小板药物的情况下进行 PEG。ASGE 建议，抗凝剂的围手术期管理应基于关于出血风险与心血管事件风险的多学科讨论。对于恶性吞咽困难患者，可以进行经口“拉”PEG 或直接 PEG 进行初始肠内通路。