WHAT IS PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG)

Percutaneous Endoscopic Gastrostomy (PEG) is an endoscopic medical procedure in which a flexible feeding tube is passed into the stomach through the abdominal wall to provide nutrition, fluids, or medications to a patient who has difficulty swallowing. This process allows the nutrition, fluids, or medications to be directly sent to the stomach without having them flow through the mouth and esophagus. It is a safe and also very common procedure for patients who have a functional gastrointestinal system but require long-term enteral nutrition. As of today, a percutaneous endoscopic gastrostomy is the most common endoscopic procedure performed worldwide.

What happens before the procedure?

Before the procedure, the patient will be assessed by the doctor and all medical history and current health condition will be examined. An antibiotic by vein is given to the patient before beginning the procedure. Moreover, a few other steps need to be considered before the procedure:

• The doctor must be informed of any special conditions such as heart or lung problems, bleeding issues or allergies, etc.
• Patients with diabetes who use insulin might be asked to reduce the dosage per recommendation from the physician
• In case the patient is taking any blood thinning medications, the physician must be informed.
• The doctor might ask the patient to refrain from aspirin and other anti-inflammatory drugs at least one week before the procedure
• The patient would be advised to not drink or eat anything at least 8 hours before the procedure
• The patient would need to be accompanied by another person since the patient would not be in a condition to drive for 24 hours at least.
• Some cases might also require the patient to stay overnight at the hospital

What happens during the procedure?

In this procedure, the doctor places an endoscope – a flexible, long, thin tube – into the mouth through the esophagus – a muscular tube connecting the mouth to the stomach – and reaches directly to the stomach to help guide the right placement for the PEG tube in the stomach, also called a feeding tube. The feeding tube is placed in the stomach and once set it comes through the skin of the abdomen. The portion that is placed in the stomach is the internal bumper and the one that comes out of the abdomen is the adapter. During the procedure, the patient might be under the influence of an intravenous sedative or local anesthesia. The procedure lasts for about 30 to 45 minutes.

What happens after the procedure?

Post the procedure, the doctor will monitor the patient carefully for any complications. As sterile dressing will be placed around the incision made to place the PEG tube. The following events are normal to occur after a percutaneous endoscopic gastrostomy.

• Drainage around the PEG tube in the first 48 hours
• Minor soreness in the abdomen where the tube is inserted

Once the area has healed and the dressing is removed, the concerned area will need to be washed with water and soap on a daily basis to avoid any infections. The care required after a PEG tube placement varies from person to person. In some cases, the tube can last for as long as 3 years, while in other cases, it may require a replacement within some months. Moreover, a dietician will direct the patient on the use and care of the PEG tube. In case a patient experiences any problem or difficulty with the PEG tube, medical help may be required.

Who benefits from a PEG tube?

A percutaneous endoscopic gastrostomy is beneficial for patients that have problems with swallowing or their appetite. Also, patients who are unable to take the required amount of nutrition through their mouth for various reasons can benefit from the PEG tube.

How is a person fed through the tube?

A person with a PEG tube is fed specialized liquid nutrition and fluids. In case, a PEG tube is placed to solve swallowing problems, such as after a stroke, there will be restrictions on the type and quantity of oral intake. Each case is different and hence, it must be discussed with the doctor.

Are there any complications after a PEG tube placement?

Some patients might experience some complications after placement of a PEG tube, such as:

• Pain at the site of the PEG tube
• Drainage from the PEG tube
• Malfunction of the PEG tube
• Infection
• Inhaling gastric contents into the lungs
• Bleeding
• Hole in the wall of the bowel

How long do these tubes last? What is the process for removal?

PEG tubes can last for months or years depending on case to case and also on the care taken. Over time, the tubes become clogged and can break down, requiring a replacement. It is very easy to remove or replace the tubes. To remove or replace the tubes, the doctor will use firm traction; in case no tube is placed, the opening is left to close. The tube can be removed or replaced without any sedatives or anesthesia; however, the doctor might suggest sedation or endoscopy in some cases.

Overall, a percutaneous endoscopic gastrostomy (PEG) is a safe and very helpful procedure in patients that require adequate nutrition and supply of food but have difficulty swallowing or other issues restricting the process.