PEG Tube Placement

(Percutaneous Endoscopic Gastrostomy)

Procedure overview

A percutaneous endoscopic gastrostomy (PEG) tube is a feeding tube that is surgically placed through your abdomen into your stomach. During this procedure, your surgeon  or gastroenterologist, uses a lighted flexible scope called an endoscope. The endoscope allows him or her  to see inside your stomach as the procedure is being done.

The PEG tube stays in your stomach for months or years to allow you to receive fluids, medicines, and nutrition when you can't take in enough nutrition by mouth. Once you have this type of tube, it is important to let your doctor know if the tube comes out, because the opening will close quickly.

Reasons for the procedure

A PEG tube may be a good choice for children or adults who can’t eat and drink enough to meet their daily nutrition needs. A PEG tube may also help prevent a dangerous condition called aspiration. Aspiration can occur if you have trouble swallowing normally and you breathe food or liquids into your lungs.

Some common conditions in which a PEG tube may be recommended include:

  • Birth defects

  • Problems swallowing

  • Stroke

  • Cancer of the mouth or esophagus

  • Diseases of the esophagus

A PEG tube may be placed if you have a long-term condition that will not allow you to swallow. Tto have this procedure, you must be able to digest food normally once the food reaches your stomach.

In some cases, such as a minor stroke from which you may recover, a PEG tube may not be a permanent solution. The average life of the PEG tube itself is about one year. Replacing the old tube is usually a simple procedure that your doctor can do without surgery or anesthesia.

Risks of the procedure

PEG tube placement is a safe procedure, but all surgeries carry some risks. You will need to sign a consent form that explains the risks and benefits of the surgery and you should discuss these risks and benefits with your surgeon. Some potential risks of PEG tube insertion include:

  • Reactions to the anesthesia

  • Pain

  • Leakage of stomach contents around the tube

  • Infection of the tube site

  • Infection that spreads inside the abdomen

  • Aspiration

  • Bleeding from the incision area

  • Bleeding or infection from damage to other organs inside the abdomen

  • Blockage or dislodgement of the tube

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your surgeon before the procedure.

Before the procedure

In the days before your surgery, tell your surgeon about any medications you take, including herbal supplements and over-the-counter medications. You may be asked to stop taking aspirin or other medications that thin your blood and may increase bleeding. These are other ways to prepare:

  • Tell your doctor if you or someone in your family has any history of reaction to anesthesia.

  • If you smoke, you may be asked to stop smoking well before surgery.

  • On the day and night before surgery, you may be given instructions on when to stop eating and drinking.

  • Ask your surgeon if you should take your regular medications with a small sip of water.

  • Wear loose, comfortable clothing on the day of surgery.

  • If you are going home after surgery, arrange to have someone drive you home and stay with you during the early recovery period.

During the procedure

You will have an intravenous line (IV) started in your hand or arm so you can receive fluids and medications. PEG tube placement is usually done under local anesthesia and sedation. You may be given pain medication and medication to make you sleepy through your IV. You may also be given antibiotics through your IV.

Before the procedure starts you will need to remove any dentures. A numbing medicine may be sprayed into your throat to prevent gagging from the endoscope. A mouth guard may also be inserted. The actual procedure takes about 20 minutes. This is what usually occurs during the procedure:

  1. Your abdomen is cleaned and a numbing medication (local anesthetic) is injected.

  2. The endoscope is passed through your mouth into your stomach.

  3. A small surgical cut is made through your skin and carried down into your stomach.

  4. The PEG tube is inserted through the opening while the surgeon watches through the endoscope.

  5. The tube is held in place inside your stomach with the help of a special balloon or a cap.

  6. A small dressing is placed at the new opening.

After the procedure

You will be taken to the recovery room to be observed while you recover from the anesthesia. You may be able to go home on the day of the procedure. Here is some of what you can expect after the procedure:

  • Expect to feel some pain, such as pain at the incision and cramping or gas pain. Follow your surgeon's instructions for pain control.

  • The dressing over the incision area can be removed after about one or two days.

  • The incision area takes about five days to heal. You will be taught to clean the area daily with soap and water. After cleaning, the area should be dried and you may use a small gauze pad to cover it.

  • Ask your surgeon when you can start showering and bathing.

  • You should be able to gradually return to normal activities, depending on your overall condition. Ask your surgeon about any activity restrictions.

  • Use of the PEG tube for feeding begins gradually with clear fluids and progresses to special formula feedings.

There is a lot to learn about using and caring for a gastrostomy tube. You will need to work closely with your medical team. The team may include doctors, nurses, pharmacists, and nutrition specialists. You will probably be told to make sure you are always upright when feeding.

Here are some of the other steps you may be taught:

  • How to care for the skin around the tube

  • What symptoms to look for that could indicate an infection

  • How to empty your stomach

  • What to do if the tube gets blocked

  • What formula to use and how to feed yourself

Tell your surgeon about any of the following:

  • Increasing pain or pain that is not relieved by medication

  • Any drainage, bleeding, redness, or swelling around the tube

  • Fever

  • Vomiting, cramping, nausea, or diarrhea

  • Aspiration (breathing food bits into the airway)

  • Dislodgement or blockage of the tube