Percutaneous Endoscopic Gastrostomy (PEG)

What is a PEG?

PEG stands for percutaneous endoscopic gastrostomy, a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach. PEG allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and esophagus. The following description will give you a basic understanding of the procedure - how it's performed, how it can help, and what side effects you might experience.

How is PEG placement performed?

Most PEG placements are nowadays done with the help of endoscopy. For this technique, your doctor will use a lighted flexible tube called an endoscope to examine the inside of your stomach and identify the best area to place the PEG. The patient receives an intravenous sedative before the procedure begins and he/she is usually asleep during the procedure. The physician will be able to see the light from the endoscope shine from the inside of the stomach through the abdominal wall. This indicates the spot for the placement of the PEG. A local anesthetic will be injected into the skin and a short incision made in this numbed up area. A hollow needle will then be advanced through the abdominal wall into the stomach and a guidewire inserted. This wire will be grabbed with the endoscope and brought out the patient's mouth. The PEG will be tied to the wire and pulled through the mouth and down the swallowing tube (esophagus) into the stomach. Once the PEG has been positioned, it will be held in place by two rubber bumpers, one on the inside of the stomach and one on the outside abdominal wall. Suturing is not usually required. Again, the entire procedure will be done with the patient sedated and asleep. Multiple variations of this technique exists, and sometimes feeding tubes are also placed by surgeons or radiologists in a somewhat different fashion. Talk to your doctor about the exact technique used.

Who can benefit from a PEG?

PEG tubes are most often placed in patients who are unable to take in enough food and calories on their own, usually because of severe swallowing problems. For example, if a patient had a stroke, their swallowing can be compromised and they may be at risk for aspirating food and fluids into their lungs. Other patients may have a growth that obstructs their swallowing tube (esophagus) or the back of their throat, or they may not be able to swallow food because of severe inflammation in the esophagus.

How should I care for the PEG tube?

A dressing will be placed over the PEG site following the procedure. This dressing will usually need to be changed on a daily basis until the small skin incision has fully healed. After that you should clean the site once a day with diluted soap and water and keep the site dry between cleansings. No special dressing or covering is needed. Pay close attention to your doctor's instructions about when and how often to change the dressings and how to care for the PEG site afterwards.

How are feedings given? Can I still eat and drink?

Specialized liquid nutrition, as well as fluids, are given through the PEG tube. Your doctor or a nutrition specialist will likely provide you with detailed instructions about the tube feedings. If the PEG tube is placed because of swallowing difficulty (e.g., after a stroke), there will still be restrictions on oral intake. Although a few PEG patients may continue to eat or drink after the procedure, this is a very important issue to discuss with your physician.

Are there complications from PEG placement?

Complications are uncommon but can occur with the PEG placement. Possible complications include pain, or infection at the PEG site, leakage of stomach contents around the tube site, and dislodgment or malfunction of the tube. Severe redness or drainage of pus at the PEG site are often an early sign of infection. Other, less common complications include aspiration (inhalation of gastric contents into the lungs), bleeding and perforation (an unwanted hole in the bowel wall). Your doctor can describe for you symptoms that could indicate a possible complication.

How long do these tubes last? How are they removed?

PEG tubes can remain in place for years if necessary. However, because they can break down or become clogged over extended periods of time, they may need to be replaced. Your doctor can easily remove or replace a tube without surgery or the need for another endoscopy. In those instances, no sedatives or anesthesia are required. Alternatively, your doctor may opt to use sedation and endoscopy in some cases to again check the inside of the stomach before placing a new tube. Your doctor will remove the tube using firm traction and will either insert a new tube or let the opening close if no replacement is needed. PEG sites close quickly once the tube is removed, so accidental dislodgment requires immediate attention.

CONDITIONS OF THE GI TRACT