Nutrition is the intake of essential nutrients in sufficient quantities and at the appropriate times to maintain and improve health and enhance quality of life.
Enteral nutrition is superior to parenteral nutrition and should be preferred. Patients should begin enteral nutrition as soon as possible to protect the gastrointestinal mucosa and maintain normal flora. In patients unable to take food orally, enteral nutrition is provided via a nasogastric/nasojejunal tube or gastrostomy tube.
Gastrostomy is the first choice for patients with a functional gastrointestinal system, poor oral intake, and requiring long-term nutritional support. Feeding tubes can be placed percutaneously or surgically. Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure that does not increase morbidity or mortality compared to surgical gastrostomy, and is cheaper and more time-saving. It was first applied in 1980 as an alternative to surgical gastrostomy. Initially described, a line was drawn between the umblicus and the middle of the left lower costal margin, and a feeding tube was inserted under local anesthesia at the junction of the middle 2/3 and the outer 1/3, with feeding starting the next day. Vudayagiri et al. reported that the placement site is generally 2 cm medial to the costal margin and 2 cm below the xiphoid process.
Different methods for placing a PEG tube into the stomach (pull technique, push technique, and Russell method) are described in the literature, with the most common being the "pull" technique. The 2005 ESPEN guidelines note that in the "pull" technique, gastroscopic visualization of the anterior gastric wall is performed, followed by determination of the puncture site at the distal corpus level.
The exact placement of the PEG feeding tube, both on the skin and within the gastric lumen, is not fully understood. Its localization on the abdominal skin will be optimally determined by endoscopic transillumination. However, its level within the gastric lumen is predictable.
In our study, we aimed to measure the distance of the feeding tube from the pylorus in patients undergoing PEG surgery, to investigate how this affects post-procedure outcomes, and to determine the optimal level within the gastric lumen. Additionally, the catheter placement on the skin will be recorded for each patient. The anatomical skin localization obtained by examining the data of all patients will be defined as the 'Triangle of Çaykara'.
Over 18 years of age
No history of major abdominal surgery (appendectomy, hernia, etc.)
Patients who started feeding 24 hours after the PEG procedure
Patients not using prokinetic agents.
History of stomach, small intestine, large intestine surgery or any history of major abdominal surgery
Having undergone surgical gastrostomy
Expected gastroparesis (hemodynamic instability, inotropic support, electrolyte imbalance, etc.)
Intestinal motility disorder
Demographic, clinical, and postoperative data of patients who will undergo PEG procedures in our hospital's surgical endoscopy unit between September 1, 2026, and September 1, 2027, as indicated by neurology, gastroenterology, and intensive care physicians, will be examined.
Cohort
Prospective
Percutaneous endoscopic gastrostomy
Procedure/SurgeryThe exact placement of the PEG feeding tube, both on the skin and within the gastric lumen, is not fully understood. In this study, researchers aimed to measure the distance of the feeding tube from the pylorus in patients undergoing PEG surgery, investigate how this affects post-procedure outcomes, and determine the optimal level within the gastric lumen. Additionally, the catheter placement on the skin will be recorded for each patient. The anatomical skin localization obtained by analyzing data from all patients will be defined as the 'Çaykara Triangle'.
Surgery-related complications
Incidence of procedure-related and early post-procedure complications
Feeding tolerance
Intolerance to enteral nutrition is typically defined by gastrointestinal symptoms such as vomiting, excessive gastric residual volumes (typically \>500 mL over 6 hours), abdominal distension, diarrhea, or constipation. All these parameters will be recorded, but particular attention will be paid to measuring excessive volumes of gastric residue.
Tube-to-pylorus distance (cm)
This is achieved by advancing a marked catheter through the PEG tube immediately after insertion, and simultaneously performing endoscopy. The distance to the pylorus is measured in centimeters.
PEG tube placement site on the skin
Determining PEG localization on the anterior abdominal wall using the xiphoid process, umbilicus, and costal margin as reference points. The anatomical skin localization obtained by examining the data of all patients will be defined as the 'Triangle of Çaykara'.
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