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Percutaneous Endoscopic Gastrostomy

(PEG)

Definition

Percutaneous endoscopic gastrostomy (PEG) is a procedure to place a tube through the belly wall. The tube will connect to the stomach.

Reasons for Procedure

A PEG makes a new path to get nutrients if the normal path is blocked. It may be needed to:
  • Feed a person who has a hard time sucking or swallowing, or who is otherwise unable to eat
  • Drain the stomach of a buildup of fluids

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems such as:
  • Aspiration—accidental sucking into the airways of fluid, food, or any foreign material
  • Damage to other organs
  • Inflammation of the belly lining
  • Infection
  • Bloating
  • Nausea
  • Diarrhea
  • Irritation of the skin near the tube
  • Blockage
  • An abnormal opening between 2 structures—fistula
Your chance of problems is higher if you:
  • Smoke
  • Drink
  • Have chronic disease such as diabetes or obesity
  • Use certain medicines
  • Have had prior surgery in the area

What to Expect

Prior to Procedure

The doctor will review the results of previous tests. You may need to have a physical exam.
Leading up to your procedure:
  • Don't eat or drink for at least 8 hours before the procedure.
  • Arrange for a ride.
  • Talk to your doctor about the medicines you take. You may be asked to stop taking some medicines up to 1 week in advance.

Anesthesia

Local anesthesia will be used. Throat and skin above the belly will be numbed. It will not make you sleep. You will be given a sedative to help you relax.

Description of the Procedure

The doctor will pass a scope through your mouth and into your stomach. The scope has a camera that will send images to a screen in the room. This will help the doctor find the right place for the PEG tube. Other tools can also be passed down the tube.
A needle will be placed through the belly wall and into the stomach. A thin, long wire will be passed through the needle, and into the stomach. A snare from the tube will grasp the wire and pull it out through the mouth. The PEG tube will then be passed over the end of the wire. The wire will be pulled back down into the stomach. It will pull the PEG tube into the stomach and out through the belly wall. A small incision may be made in the skin to allow tube to pass through skin. A bumper inside the stomach will stop the PEG tube out from leaving the stomach. The wire will be removed. A second bumper will be placed around the PEG tube outside the belly wall. This will keep the tube from sliding in. A bandage will be placed over the area. The PEG tube will be taped to the belly.
Percutaneous Endoscopic Gastrostomy Procedure
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How Long Will It Take?

30 to 45 minutes

Will It Hurt?

Anesthesia will prevent pain during surgery. You will feel sore for a few days after the placement. Medicines will ease pain during recovery.

Average Hospital Stay

You may need an overnight stay. If you have problems, you may need to stay longer.

Post-procedure Care

At the Hospital
Your care team will watch for complications as you recover. Care may include:
  • Medicine to ease pain or stop blood clots
  • Encouraging you to get up and walk as soon as possible
During your stay, the care team will take steps to lower your chances of infection such as:
  • Wash their hands.
  • Wear gloves or masks.
  • Keep your incisions covered.
There are also steps you can take to lower your chances of infection such as:
  • Wash your hands often. Remind visitors to do the same.
  • Remind your care team to wear gloves or masks.
  • Do not allow others to touch your tube.
At Home
You will need to:
  • Take care of the PEG tube. This includes changing the dressing and cleaning the around the site. You will also need to watch for signs of infection.
  • Follow nutrition plan given by your care team.

Call Your Doctor

Call your doctor if any of these occur:
  • Pain that you can't control with the medicines you were given
  • The tube falls out—could lead to closing of opening if not replaced quickly
  • The tube isn't working as it should
  • Fever and chills
  • Redness, swelling, pain, excess bleeding, or pus from the PEG site
  • Headaches, muscle aches, lightheadedness, or general ill feeling
  • Nausea, vomiting, constipation, or swelling in the belly
If you think you have an emergency, call for emergency medical services right away.

RESOURCES

American Gastroenterological Association
https://www.gastro.org
American Society of Colon and Rectal Surgeons
https://www.fascrs.org

CANADIAN RESOURCES

Canadian Association of Gastroenterology
https://www.cag-acg.org
The College of Family Physicians of Canada
https://www.cfpc.ca

References

Avitsland TL, Kristensen C, Emblem R, et al. Percutaneous endoscopic gastrostomy in children: A safe technique with major symptom relief and high parental satisfaction. J Pediatr Gastroenterol Nutr. 2006;43(5):624-628.
Ljungdahl M, Sundbom M. Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial. Surg Endos. 2006;20(8):1248-1251.
Percutaneous endoscopic gastrostomy (PEG). American College of Gastroenterology website. Available at: http://patients.gi.org/topics/percutaneous-endoscopic-gastrostomy-peg. Accessed August 24, 2018.
Understanding percutaneous endoscopic gastrostomy (PEG). American Society for Gastrointestinal Endoscopy website. Available at: https://www.asge.org/home/for-patients/patient-information/understanding-peg. Accessed August 24, 2018.
6/2/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T905141/Treatment-for-tobacco-use : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.

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