Percutaneous Endoscopic Gastrostomy (PEG)
Information for patients having a PEG insertion.
What is PEG?
PEG stands for Percutaneous Endoscopic Gastrostomy. This is a procedure in which a feeding tube is placed directly into your stomach through the abdominal wall. It allows nutrition, fluids and medications to be put directly into the stomach.
Why do I need it?
PEG is needed when people cannot take adequate food and drinks by mouth either because of difficulty in swallowing or for other reasons. PEG feeding is the best way to provide liquid nourishment and medications directly into your stomach without taking food through your mouth.
How is a PEG put in?
The procedure will take place in the endoscopy unit. You will need to fast (nothing to eat or drink) for 8 hours before the procedure. In the procedure room the nurse will attach monitors for recording your pulse and blood pressure. You will be given some oxygen to breath through your nose. Your throat may or may not be sprayed with local anaesthetic before you are given a sedative through a needle in your arm or hand. You may be given some antibiotics to reduce the risk of infection. A mouth guard will be placed between your teeth so that you do not accidentally bite the endoscope.
With you lying comfortably, the endoscope (flexible tube with a light and camera at the end) is passed via the mouth into the stomach. The correct place to put the tube is located and the skin is injected with a local anaesthetic. A small cut is made in the skin and the PEG tube is then positioned through the cut in the skin.
Insertion of a PEG tube usually takes 30 minutes to complete.
What happens next?
PEG tube is mostly put in while you are an inpatient in the hospital. After the procedure you will return to your ward area. Rarely you may be allowed home, but that will depend upon why the PEG is being inserted and how sick you are.
You may have sore throat for a day or so after the procedure. You may feel bloated because of the air put in your stomach during the procedure. This settles quickly. You may have minor soreness in your abdomen where the PEG tube was inserted. This will feel like a pulled muscle. This settles in a couple of days and can be managed with simple painkillers. There may be some drainage around the PEG tube for the first 24-48 hours. A sterile gauze dressing will be placed around the cut.
Feeds using the tube usually start with clear fluids between 4 and 24 hours after the procedure. Your dietician will help choose the best feeds for your needs.
Is there any complication from PEG placement?
Yes. PEG procedure is generally safe but complications can occur. The likelihood of complications is more if you are very unwell.
The most common complication is wound infection. This can be treated with simple antibiotics. Other complications include nausea and vomiting for a few days or bleeding from the wound.
Other complications occur rarely but are more serious and may even be life threatening. These include a severe infection of the abdominal wall or damage to the oesophagus (food pipe), stomach or bowel at the time of examination. These complications usually require urgent treatment and even an operation.
There may be problems with the PEG tube like blockage, accidental removal or aspiration (inhalation) of the food into the lungs. These problems with the tube may occur over weeks or months.
How long would I need it?
PEG tube may be temporary or permanent. This will depend on why the PEG is being inserted.
PEG tube usually has a long life (months to years) but can be replaced when necessary. An endoscopy is usually required when replacing the tube. Usually the new tube can be put in through the same ‘hole’ (stoma) as your current tube.
Frequently asked questions.
How should I care for the PEG tube?
Most people can manage PEG tube with very little help. You and your carers will be advised on how to care for your tube. You will be given contact numbers if you need advice. It takes about 2 weeks for the ‘stoma’ or channel to form around the tube. So after 2 weeks you can bath and even go swimming.
How are feedings given?
Liquid feeds are given through the PEG tube using a large syringe, a drip using a tube connected to a hanging plastic bag or a mechanical pump. The special liquid feed contains all the essential nutrients that you would normally get from a healthy balanced diet.
Can I still eat and drink?
A PEG does not prevent a patient from eating or drinking. So if you can swallow safely without choking, there is no reason why food cannot be taken by mouth in addition to the liquid supplement through PEG tube.
What if the tube is pulled out?
It is very important not to pull out the tube in the first week after PEG tube placement. Serious complications could occur. But once the wound heals in a couple of weeks, there is not much risk in removal of the tube.
NB- it can’t answer all of your questions, since a lot depends on the individual patient and the doctor’s professional judgement. Please ask your doctor about anything you don’t understand.
