Percutaneous Endoscopic Gastrostomy (PEG)

Percutaneous endoscopic gastrostomy (PEG) is a medical procedure that involves the placement of a flexible feeding tube through the abdominal wall and into the stomach; it allows for direct access to the stomach for nutritional support. This procedure is typically performed to provide nutrition to patients who have difficulty swallowing or are unable to consume food orally due to various medical conditions.

Indications

• Neurological disorders (e.g., stroke, amyotrophic lateral sclerosis)
• Cancer of the head and neck
• Esophageal obstruction or stricture
• Dysphagia (difficulty swallowing)
• Cerebral palsy or other conditions that affect the ability to eat

Procedure

The PEG procedure is usually performed by a gastroenterologist or a surgeon in an endoscopy suite. The patient typically receives conscious sedation and local anesthesia to minimize discomfort during the procedure.

1. The patient lies on their back on an examination table.
2. The abdomen is cleaned and prepared with antiseptic solution.
3. A local anesthetic is injected into the abdominal wall where the tube will be inserted.
4. An endoscope (a flexible tube with a camera and light) is passed through the mouth, down the esophagus, and into the stomach.
5. The stomach is inflated with air to facilitate visualization.
6. A small incision is made in the abdominal wall, and the PEG tube is inserted through this opening and guided into the stomach using the endoscope for visualization.
7. The internal bumper of the PEG tube is placed against the stomach lining, securing it in position.
8. The external portion of the tube is secured to the skin with tape or a fixation device.

Post-Procedure Care

After the procedure, patients are monitored for several hours to ensure there are no immediate complications. Instructions are provided on how to care for the PEG site and use the feeding tube for nutrition and medication administration.

• Keeping the PEG site clean and dry to prevent infection
• Administering feedings and medications as prescribed
• Avoiding submerging the PEG site in water (e.g., taking a bath) until it is fully healed
• Following up with healthcare providers for regular check-ups and to address any concerns or complications

Potential Complications

While generally considered safe, the PEG procedure can be associated with several potential complications:

• Infection of the PEG site
• Bleeding from the stomach or abdominal wall
• Leakage around the tube
• Blockage or dislodgement of the tube
• Nutritional deficiencies if feedings are not properly managed

Removal of PEG Tube

The PEG tube can be removed when it is no longer needed, typically through a simple procedure in an outpatient setting. The removal process involves deflating the internal bumper and gently pulling out the tube. The site usually heals quickly without needing sutures.