Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement

Introduction

Percutaneous endoscopic gastrostomy (PEG) tube placement is a medical procedure used to insert a feeding tube directly into the stomach through the abdominal wall. This procedure allows for direct access to the stomach, enabling patients who have difficulty swallowing or are unable to eat and drink normally to receive essential nutrients.

Indications

PEG tube placement is typically indicated for patients with conditions such as:

• Dysphagia (difficulty swallowing)
• Cerebral palsy or other neurological disorders
• Head and neck cancer
• Amyotrophic lateral sclerosis (ALS)
• Stroke or brain injury
• Gastroesophageal reflux disease (GERD)
• Malnutrition or dehydration due to inability to eat and drink normally

Contraindications

PEG tube placement may be contraindicated in patients with:

• Prior abdominal surgery or presence of intrauterine devices (IUDs)
• Presence of shunts or other implanted devices in the abdomen
• Ascites (fluid accumulation in the abdominal cavity)
• Peritoneal dialysis or presence of a peritoneal catheter
• Pregnancy or suspected pregnancy
• Active gastrointestinal bleeding or perforation

Procedure

The PEG tube placement procedure typically involves the following steps:

1. Patient preparation: The patient is given local anesthesia and sedation to minimize discomfort and anxiety.
2. Endoscopy: A flexible endoscope is inserted through the mouth and guided into the stomach.
3. Stomach insufflation: Air is introduced into the stomach to distend it and facilitate visualization.
4. Abdominal wall puncture: A needle is inserted through the abdominal wall and into the stomach under endoscopic guidance.
5. Guide wire insertion: A guide wire is inserted through the needle and into the stomach.
6. PEG tube placement: The PEG tube is inserted over the guide wire and into the stomach, with the internal bumper positioned against the gastric mucosa.
7. External fixation: The external portion of the PEG tube is secured to the abdominal wall using a fixation device.

Post-Procedure Care

After PEG tube placement, patients typically require:

• Pain management: Medication may be prescribed to manage discomfort or pain at the insertion site.
• Wound care: The insertion site should be kept clean and dry to promote healing and prevent infection.
• Feeding regimen: A dietitian or healthcare provider will develop a feeding plan tailored to the patient's nutritional needs.
• Follow-up care: Regular follow-up appointments are necessary to monitor the PEG tube site, assess nutritional status, and address any complications or concerns.

Complications and Risks

Possible complications and risks associated with PEG tube placement include:

• Infection: Bacterial colonization or infection at the insertion site.
• Bleeding: Hemorrhage or bleeding from the stomach or abdominal wall.
• Perforation: Accidental puncture of surrounding organs, such as the intestine or liver.
• Tube dislodgement: Accidental removal or displacement of the PEG tube.
• Nutritional deficiencies: Inadequate nutrition or electrolyte imbalances due to improper feeding regimen.

Removal and Replacement

PEG tubes can be removed or replaced as needed. Removal is typically performed endoscopically, while replacement may involve a new PEG tube placement procedure or the use of a different type of feeding tube.