Overview
- What is a PEG?
A percutaneous endoscopic gastrostomy (PEG) is a procedure for placing a feeding tube directly from the skin of the abdomen into the stomach with the guidance of an instrument known as an endoscope. This can be very helpful for people who cannot safely eat enough calories due to a variety of conditions (stroke, head and neck cancer, esophagus problems, weakness, etc.).
- Why would need someone need a PEG tube?
A PEG tube can be helpful for children and adults that are unable to safely consume enough food to meet their nutritional needs, and are still able to digest food in their stomach and intestines. Common conditions that warrant a PEG tube placement include:
- Stroke
- Cancer of the mouth or neck
- Weakness of the mouth/neck muscles due to other illness
When someone is being considered for a PEG tube placement, their life expectancy and quality of life after the tube is placed are always assessed to see if the procedure is appropriate.
- What is the medical procedure for placing a PEG tube?
PEG tubes are placed with the aid of an endoscope (a thin camera that is inserted through the mouth to see inside the stomach and intestines).
1. The patient first receives medication through an IV to make them sleepy and comfortable.
2. A good location is selected on the patient's abdomen and a small cut is made in the skin.
3. The PEG tube is then inserted carefully through the cut in the skin and into the stomach.
The procedure usually takes 15-20 minutes.
- Is there discomfort after the procedure?
There will be some minimal discomfort after the procedure from either cramping from gas in the digestive system or pain at the incision site itself. This pain can be well controlled with pain medication if required.
- Will the tube fall out once it is placed?
PEG tubes come in 2 different styles and have different ways to ensure they stay in place.
1. Some tubes have a rubber cap (internal bumper) that sits in the stomach to hold it in place
2. Other tubes have a small balloon that is inflated in the stomach hold it in place
- What does the PEG tube look like on the outside after placement?
The PEG tube will look like a small, flexible plastic tube about 6"-12" long coming out of the skin over the abdomen. There will be a small rubber disk or bar that sits against the skin to help keep it in place. The end of the tube will have a cap with one or two holes and a cover to prevent food/water from escaping from the stomach. Patients can use special syringes to either inject or remove food and water through this cap.
- What are the complications of a PEG tube?
Complications from this procedure may occur. Minor complications include leakage of food or fluid around the tube onto the skin, pain at the incision site, mild bleeding at the incision site or infection at the incision site. You should consult with your doctor if this occurs. Major complications are rare but can occur and include major bleeding, peritonitis (an infection inside the abdominal) and damage to the colon or other surrounding organs. Delayed complications include “buried bumper” syndrome in which the internal bumper buries itself into the stomach wall. This can be avoided by not tightening the external bumper too tightly.
- Are there alternatives to PEG?
There are alternatives to PEG tubes.
1. Nasogastric (NG) feeding tubes are long, thin tubes that pass through the nose and into the stomach. They are designed to be temporary as long-term use can cause irritation, infection, or bleeding in the nose or throat.
2. Gastrostomy tubes (similar to PEG tubes) but placed by a surgeon in the operating room or by radiology using X-rays to help guide them
3. Jejunostomy tubes which are similar to PEG tubes except they are placed from the skin into the small intestine (instead of the stomach)
- How do you take care of a PEG tube?
The area around the incision on the abdominal wall should be cleaned daily and the incision may be covered with clean gauze. Often, these gauze sponges have a slit in them so they can be placed around the PEG tube, over the incision. The tube itself has centimeter markings written on the side. The centimeter marking at or near the incision site should be noted. If this number changes, the tube should be readjusted back to the original centimeter marking. The external bumper should rest gently near the abdominal wall. This external bumper should not be placed too tightly against the abdominal wall or it may lead to infection or skin ulceration.
Should the tube accidentally come out, it must be replaced within twenty-four hours or the incision may begin to close and new PEG procedure may be required. If the tube falls out, a physician should be contacted as soon as possible. A urinary (Foley) catheter can be temporarily inserted into the incision to keep it open until a replacement PEG tube can be placed. If the tube needs removal or replacement, it is usually wise to wait 6 or more weeks after insertion before removal.
- What should be put into the PEG tube?
Only prescription formula, water, and medications should be placed into the PEG tube. After it is placed, a dietitian, nurse, pharmacist, or physician will determine what formula is best suited for the patient's needs. The prescription formula is designed to provide the necessary calories, nutrients, vitamins, and minerals.
- How is a PEG tube used for feeding?
The PEG tube is relatively narrow. Commercial tube feedings are available and are designed to reduce the risk of tube clogging. The PEG tube should be flushed with water before and after feedings, or after medications have been administered. The placement of table foods into the PEG tube is discouraged as it can lead to tube clogging. It is imperative that the caregiver or patient thoroughly washes their hands with soap and water before preparing formula or having contact with the PEG system.
The commercial tube feeding formula is administered at room temperature. The patient should be upright, no less than thirty degrees, to minimize the risk of regurgitation and potential aspiration (tube feeding getting into the lungs). The patient should be kept upright for thirty to sixty minutes after feeding. To prevent complications (abdominal cramping, nausea and vomiting, bloating, diarrhea, aspiration), tube feeding should be infused slowly.
The simplest method of infusing tube feeding through the PEG tube is called bolus feeding. Tube feed formula is placed within a large syringe and slowly administered to the patient through the plug cap on the end of the PEG feeding tube. In order to meet a patient’s nutritional needs, this may need to be repeated 4 to 6 times per day. Sometimes continuous feeding is preferable. With this method, a feeding pump is set up and connected to the PEG tube. The tube feed formula is placed in a large bag and attached to the pump. The tube feeding is continuously administered by the pump over 12-24 hours.
- Can I put medications through a PEG tube?
Most medications that come in tablet or pill form can be crushed and dissolved in water and passed through the feeding tube. In addition, there may be liquid formulations of medications that can be prescribed. However, some capsules are designed to dissolve within various portions of the gastrointestinal tract and therefore cannot be broken up. The tube should be flushed with water after introduction of medication to prevent clogging. Ask your doctor or pharmacist about specific medications.
- Is a PEG tube permanent?
Depending on the medical condition, a PEG feeding tube may be temporary or permanent. After a minor stroke, for example, a patient may recover swallowing and ultimately be able to get adequate calories and nutrients from eating by mouth. However, those with more permanent neurologic damage may require a feeding tube long-term. In either case, the feeding tube can be easily removed if necessary.
- Do PEG feeding tubes last forever?
The lifespan of the PEG feeding tube is about 1 year although the tube may wear out sooner. When the tubing begins to wear, you will notice pits, bumps and leaks on the side of the tube. In addition, the feeding tube cap may split or fail to close properly. You should notify your physician if this develops.
- How is a PEG tube removed?
PEG tube removal should only be done by a trained healthcare provider. If the brand of tube has a soft internal mushroom bumper, it can be removed by pulling. This may cause some transient stinging and burning at the incision site. If it has a balloon internal bumper, the balloon is deflated and the tube is removed. There are also unique commercial PEG brands that require other methods of removal.
Author(s) and Publication Date(s)
Bruce T. Kalmin, MD, Atlanta Gastroenterology Associates, Atlanta, GA – Updated December 2012.
Abhinav Vemula, MD, Boston Medical Center, Boston, MA – Updated July, 2021.
Mark DeLegge, MD, FACG, Digestive Disease Center, Medical University of South Carolina, Charleston, SC and Bruce T. Kalmin, MD, Atlanta Gastroenterology Associates, Atlanta, GA – Published November 2007.