Patient education: Percutaneous endoscopic gastrostomy (PEG) in adults (The Basics)

What is percutaneous endoscopic gastrostomy? — Gastrostomy is a procedure to put in a feeding tube. Feeding tubes are a way to get nutrients if you cannot get enough nutrition from eating or drinking by mouth.

"Percutaneous endoscopic gastrostomy," or "PEG," is a specific way of putting in a feeding tube. It involves using a tool called an "endoscope." An endoscope is a thin, flexible tube with a light and tiny camera on the end (figure 1). It lets the doctor see inside the body. The endoscope goes into the mouth and esophagus, and then into the stomach. The camera on the end helps the doctor find the right place to put in the feeding tube.

A feeding tube put in this way is called a "PEG tube." PEG tubes are a type of "gastrostomy tube," or "G tube."

PEG tubes are usually needed for people who will be unable to get enough nutrition from eating or drinking for 4 weeks or longer. Your doctor will talk to you about how long you will need the PEG tube before it is put in.

How do I prepare for PEG? — The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might want you to get tests, such as:

●X-ray

●Lab tests

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Fasting – This means not eating or drinking anything for a period of time.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during PEG? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia used for PEG tube placement include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain.

•Sedation – This type of anesthesia helps you relax so you are comfortable during the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will put the endoscope down your throat and into your stomach. The camera on the end will send pictures to a screen. This helps the doctor to decide where to place the PEG tube.

●The doctor will give you a shot in the skin of your belly to numb the area. Then, they will make a small cut (incision) and insert a thin tube called a "catheter."

●The doctor will push a thin wire through the catheter and into your stomach. A device attached to the endoscope grabs hold of the wire, and the doctor carefully pulls the wire up through your throat and mouth.

●Then, the PEG tube is attached to the wire. The doctor will gently pull on the end of the wire coming out of your stomach. This helps to guide the PEG tube down your throat and into your stomach. Once the PEG tube is in your stomach, the doctor will continue to gently pull the wire until the PEG tube is in the correct position. Part of the PEG tube will be inside your stomach, and part of it will be outside of your belly.

●Once the PEG tube is in the right position, it will be held in place by a small bumper on the inside of the stomach. This keeps the PEG tube in the right place and stops it from coming out.

What happens after PEG? — After the procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●You will see a bandage over the place where the tube enters your body.

●The staff will help you get out of bed and start moving around when you are able.

Somewhere between 3 to 24 hours after surgery, a doctor or nurse will "flush" the PEG tube with water. You will probably get your first feeding through the tube the day after surgery.

What are the risks of PEG? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Infection

●The tube coming out, getting clogged, or leaking

What else should I know? — Before you go home from the hospital, make sure that you know how to keep the tube and incision clean. You also need to know how, when, and what to feed yourself through the tube. Ask what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

If you will need the PEG tube for a long period of time, it might need to be replaced at some point. Your doctor will explain your options for replacing it.

More on this topic

Patient education: Percutaneous endoscopic gastrostomy (PEG) – Discharge instructions (The Basics)
Patient education: Surgical gastrostomy (The Basics)
Patient education: Enteral (tube) feeding (The Basics)
Patient education: How to give a tube feeding (The Basics)
Patient education: How to care for a nasogastric tube (The Basics)
Patient education: How to care for a G tube or G button (The Basics)