Percutaneous Endoscopic Gastrostomy (PEG)

A percutaneous endoscopic gastrostomy (PEG) is a surgery to place a feeding tube. Feeding tubes, or PEG tubes, allow you to receive nutrition through your stomach. You may need a PEG tube if you have difficulty swallowing or can’t get all the nutrition you need by mouth.

What is percutaneous endoscopic gastrostomy?

A percutaneous endoscopic gastrostomy (PEG) is a procedure to place a feeding tube. These feeding tubes are often called PEG tubes or G tubes. The tube allows you to receive nutrition directly through your stomach. This type of feeding is also known as enteral feeding or enteral nutrition.

Who needs a PEG tube?

You may benefit from a PEG tube if you have difficulty swallowing (dysphagia). Causes of dysphagia may include:

  • Brain injury.
  • Head and neck cancer.
  • Stroke.
  • Chronic appetite loss due to severe illnesses like cancer.

Feeding tubes may also be useful if you have a condition that interferes with how your body processes nutrition. For example, you may benefit from a PEG tube if you have cystic fibrosis or receive dialysis for kidney failure. Someone in a coma may receive a PEG tube to help keep them alive.

Procedure Details

What happens before percutaneous endoscopic gastrostomy?

Before surgery, you’ll meet with your surgeon to discuss the procedure. You need to tell your provider if you have any heart conditions, bleeding risks or medication allergies.

Depending on your health and underlying conditions, you may need to make medication adjustments. Your healthcare team may recommend changes to:

  • Insulin dosage.
  • Medicines that thin your blood, such as warfarin (Coumadin®).
  • Nonsteroidal anti-inflammatory drugs, such as aspirin (Bayer®) or ibuprofen (Advil® or Motrin®).

Don’t eat or drink at least eight hours before the surgery. You also need to arrange a ride home after surgery.

What happens during percutaneous endoscopic gastrostomy?

Most healthcare providers place PEG tubes with endoscopic surgery. Endoscopic procedures use small incisions and a long, flexible instrument called an endoscope.

On the day of surgery, you receive intravenous (IV) anesthesia and antibiotics. The anesthesia ensures that you remain calm and numb during the procedure. The antibiotic prevents infection.

You may also receive a local anesthetic. A local anesthetic is an injection of numbing medicine. You receive this injection near where your surgeon makes the incision.

During percutaneous endoscopic gastrostomy, your provider:

  1. Makes a small incision in your upper abdomen.
  2. Places the tube through the incision.
  3. Connects the tube to your stomach.

The entire procedure only takes around 20 to 30 minutes. Usually, you can return home the same day or the next morning.

What happens after percutaneous endoscopic gastrostomy?

You’ll feel some pain after a percutaneous endoscopic gastrostomy. This pain might be from the incision. Or you might have cramping from gas buildup in your digestive system. This pain should decrease within 24 to 48 hours.

You’ll have a bandage over the incision site. You may see some drainage around the incision for up to 48 hours. Usually, your surgeon will give you instructions to remove the bandage after one to two days.

After the area around your feeding tube heals, you’ll meet with a dietitian. This specialist explains how to use the PEG tube and starts you on enteral nutrition.

Can you see the PEG tube outside the body after surgery?

Yes. PEG tubes are about the size of a pen or pencil. You’ll see 6 to 12 inches of the tube coming out of the incision area. Around the tube is a disc called an external bumper. This bumper prevents the tube from going further into your stomach.

At the end of the feeding tube is a small cap or plug. This plug prevents stomach acid or contents from leaking onto your skin or clothes. You can open this plug to receive food, water or medications.

Risks / Benefits

What are the advantages of PEG tubes?

PEG tubes are an important treatment if you have difficulty swallowing or are unable to get adequate nutrition. After G tube placement, you receive specialized nutrition and hydration.

What are the risks or complications of PEG tubes?

Possible risks of percutaneous endoscopic gastrostomy include:

  • Accidental tube dislodgement (tube moving out of place or coming out).
  • Aspiration (accidentally inhaling your stomach contents).
  • Bleeding and perforation (hole in the wall of your bowel or intestine).
  • Infection near the incision.
  • Pain near the PEG tube.
  • Stomach leakage around the tube.

Your provider will explain the symptoms of a PEG tube complication and when to seek treatment. You’ll need to clean your PEG tube daily to decrease your risk of complications.

Recovery and Outlook

What is the outlook after a G tube placement?

Most people with G tubes have no problems or complications after surgery. However, your outlook depends on the underlying medical condition that led to tube placement.

Can I eat and drink by mouth with a PEG tube?

After tube placement, most people receive fluids and liquid nutrition through the tube. People who need PEG tubes because of swallowing problems have restrictions on eating and drinking by mouth. Some people may still eat and drink small amounts through the mouth. Talk with your provider about eating and drinking restrictions.

How long do PEG tubes last?

PEG tubes can last for months or years. They may clog or wear down over time. If your G tube is wearing out, you may notice:

  • Bumps on the tube.
  • Leaking.
  • Pits or indentations on the tube.

If you need a new PEG tube, your provider can easily replace the tube without invasive surgery or anesthesia. If you don’t need the tube anymore, your provider may remove the tube. The opening in your stomach closes on its own.

When to Call the Doctor

When should I see my healthcare provider?

If your PEG tube accidentally falls out or moves, contact your healthcare provider right away. The opening in your stomach where the G tube goes can close very quickly. If the tube dislodges, it’s important to receive medical treatment within 24 hours.

A note from Cleveland Clinic

PEG tubes are feeding tubes. They deliver nutrition directly to your stomach. You receive a PEG tube through a short procedure called a percutaneous endoscopic gastrostomy. In this procedure most people can go home the same day. After your feeding tube is placed, you’ll be able to see the tube outside your body. You will need to clean the tube daily and keep it dry between cleanings. If a PEG tube falls out or moves, see a healthcare provider within 24 hours.

Percutaneous endoscopic gastrostomy (PEG) feeding tubes are now being used more often than in the past. PEG feeding is used if you have problems with swallowing or if you cannot eat and drink enough. PEG is usually the recommended method of help with feeding if your bowel is working normally and you need long-term help with feeding.

IN THIS ARTICLE

What is a PEG feeding tube?

A percutaneous endoscopic gastrostomy (PEG) feeding tube is a way to give food, fluids and medicines directly into the stomach by passing a thin tube through the skin and into the stomach.

  • Percutaneous means through the skin.
  • Endoscopic means that a small, long, thin and flexible tube (endoscope) is used to position the PEG feeding tube into the stomach.
  • Gastrostomy means making an opening into the stomach.

For tube feeding over long periods of time, PEG feeding tubes are more comfortable and easier to use than a tube passed through your nose and down into your stomach (nasogastric tube). PEG feeding tubes can also be hidden under your clothes so that no one needs to know you’ve got one.

The PEG feeding tube has a small plastic disc inside your stomach and another small disc on top of your skin where the tube is inserted. These discs prevent the tube coming out or the whole tube ending up in your stomach.

What are the reasons for using a PEG feeding tube?

  • A PEG feeding tube can be used if you have difficulty swallowing or have a problem that causes a risk of swallowed food going into your lungs rather than into your stomach. The possible causes of these problems include having a stroke or a condition that causes weakness of the muscles needed to make sure that all swallowed food ends up in the stomach rather than in the lungs.
  • A PEG feeding tube can also be used if normal feeding is not enough to provide all of the body’s needs. Examples of this may be for people with cystic fibrosis or if you need to have dialysis for kidney failure.
  • PEG tubes may also be used for many other conditions such as bowel cancer, after a head injury, Crohn’s disease or severe burns.
  • A PEG feeding tube may be used for children as well as adults. A child may need a PEG feeding tube for various conditions, including any condition that causes swallowing problems.

When should a PEG feeding tube not be used?

A PEG feeding tube cannot be inserted if you have a problem with blood clotting, if you are very unwell, or if you have a severe infection. There may be other reasons why a PEG feeding tube is not a good idea for you and this can be discussed with your specialist and nurse.

How is the PEG tube inserted?

The PEG tube is usually inserted in the hospital endoscopy unit. Adults do not usually need to have a general anaesthetic but you will usually given an injection of a sedative to make you sleepy and relaxed. A local anaesthetic is used to numb the area of skin where the PEG tube is to be inserted. Children do need a general anaesthetic for the insertion of the PEG feeding tube.

You will be given an antibiotic and the area of skin over your stomach will be cleaned thoroughly to reduce the risk of any infection.

The procedure is not painful but you may feel some pressure over your stomach while the tube is being inserted. The whole procedure usually takes between 20 and 30 minutes. Feeding through the PEG tube can often be started about four hours after the tube has been inserted.

How is the PEG tube managed after insertion?

You will be shown how to use the feeding tube by nurses while you are in hospital. You must make sure you’re completely happy with using the tube, so ask about anything you’re not sure about.

It is very important to make sure the area of skin where the tube has been inserted (insertion site) remains free of any infection, especially during the first 10 days after the insertion. You should be given clear instructions about looking after the area where your PEG has been inserted, including washing the area with soap and water. If you think the skin may be infected or if you have any concerns then you should contact your nurse or your GP.

What are the complications?

Most people don’t have any problems as a result of having a PEG tube inserted, apart from some discomfort for the first few hours after the insertion. However, minor problems can occur, such as infection around the skin where the tube has been inserted or some leakage around the tube.

Sometimes the insertion site will be uncomfortable with some pain for up to one week after the insertion. This may make you reluctant to take deep breaths but it is very important to breathe as normally as possible. This is because taking shallow breaths may increase your risk of a chest infection.

Major complications are very uncommon but include:

  • Breathing problems during or after the tube is inserted.
  • Bleeding.
  • The tube causing a hole in the bowel (bowel perforation).
  • Infection in your tummy (abdomen).
  • A very small risk of death as a result of having a PEG tube inserted.

What is the outlook?

For most people with a PEG feeding tube there are no problems or side-effects when the tube is inserted and no problems with having the tube. However, the outlook (prognosis) will depend on the underlying medical condition.