Percutaneous endoscopic gastrostomy (PEG)

Overview

A Percutaneous Endoscopic Gastrostomy (PEG) procedure entails the placement of a feeding tube, often known as a PEG tube or G tube. This tube enables the direct administration of nutrition into the stomach. This feeding type known as enteral feeding or enteral nutrition.

Reasons for undergoing the procedure

Utilizing a PEG tube can be advantageous for individuals experiencing difficulty swallowing (dysphagia). Dysphagia may stem from diverse factors, such as brain injury, head and neck cancer, stroke, or chronic appetite loss due to severe illnesses like cancer. Moreover, if you have a condition impeding your body’s ability to process nutrition, such as cystic fibrosis or undergoing dialysis for kidney failure, a PEG tube may offer benefits. In scenarios where an individual is in a coma, a PEG tube can be utilized to administer essential nutrition and sustain their survival.

Risks

Potential risks associated with PEG include:

• Bleeding
• Perforation (formation of a hole in the bowel wall).
• Infection in the vicinity of the incision.
• Leakage around the tube from the stomach.
• Pain in the proximity of the PEG tube.
• Accidental displacement of the tube (shifting out of place or dislodging).
• Aspiration (unintentional inhalation of stomach contents).

Daily cleaning of your PEG tube is necessary to mitigate the risk of complications. Your doctor will elucidate the symptoms indicative of PEG tube complications and advise you on when to seek medical attention.

Before the procedure

Prior to the surgical procedure, you will have a consultation with your surgeon to go over the details. It is crucial to inform your doctor about any existing heart conditions, bleeding risks, or medication allergies.

Depending on your overall health and underlying conditions, adjustments to your medication may be necessary. Your healthcare team might suggest modifications to:

• Blood-thinning medications like warfarin.
• Nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen.
• Insulin dosage.

Ensure that you abstain from eating or drinking for a minimum of eight hours before the scheduled surgery. Additionally, make arrangements for transportation home after the surgery.

During the procedure

Most doctors typically perform PEG tube placements using endoscopic surgery. Endoscopic procedures involve small incisions and the use of a flexible instrument known as an endoscope.

On the day of the surgery, you will be administered Intravenous (IV) anesthesia and antibiotics. The anesthesia keeps you relaxed and numb during the procedure, while the antibiotic works to ward off infections. Additionally, a local anesthetic, an injection of numbing medicine, may be administered near the incision site.

During the percutaneous endoscopic gastrostomy, your doctor:

• Makes a small incision in your upper abdomen.
• Inserts the tube through the incision.
• Connects the tube to your stomach.

The entire procedure typically lasts around 20 to 30 minutes. In most cases, you can return home either on the same day or the following morning.

After the procedure

Following a percutaneous endoscopic gastrostomy, you may experience some discomfort, which could arise from the incision or cramping due to gas accumulation in your digestive system. Typically, this discomfort should diminish within 24 to 48 hours.

A bandage will be placed over the incision site, and you might notice some drainage around it for up to 48 hours. Your surgeon will likely provide instructions for removing the bandage after one to two days.

Once the area around your feeding tube has healed, you will have a meeting with a dietitian. This specialist will guide you on the proper usage of the PEG tube and initiate you into enteral nutrition.

PEG tubes are approximately the size of a pen or pencil, with 6 to 12 inches of the tube visible outside the incision area. Encircling the tube is a disc known as an external bumper, which acts as a barrier to prevent the tube from advancing deeper into your stomach. Towards the end of the feeding tube, there is a small cap or plug. This plug serves to prevent the leakage of stomach acid or contents onto your skin or clothing. You can open this plug whenever you need to access food, water, or medications.

Outcome

The majority of individuals with G tubes typically encounter minimal problems or complications post-surgery. However, the prognosis is heavily influenced by the underlying medical condition that necessitated the tube placement.

Following tube placement, most individuals receive fluids and liquid nutrition through the tube. Those who require PEG tubes due to swallowing difficulties often encounter restrictions on oral intake. While some may still consume small amounts orally, it’s crucial to discuss any eating and drinking constraints with your doctor.

PEG tubes typically have a lifespan ranging from months to years but may experience clogging or wear down over time. Signs of tube wear out may include leaks, bumps or pits on the tube.

If replacement becomes necessary, your doctor can easily perform the procedure without invasive surgery or anesthesia. If the tube is no longer required, your provider can remove it, and the stomach opening will naturally close.