Outpatient Percutaneous Endoscopic Gastrostomy
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Percutaneous Endoscopic Gastrostomy (PEG or “G -tube”) Hospital Outpatient
What is a percutaneous endoscopic gastrostomy?
A percutaneous endoscopic gastrostomy (PEG or G tube) is the least invasive way of placing a feeding tube directly into the stomach through the abdominal wall to allow “enteral feeding”, that is, putting food directly into the digestive tract and bypassing the mouth and esophagus. In the outpatient situation, this brochure describes the procedure for an individual who has a temporary inability to swallow sufficient nourishment, but who is expected to recover after some weeks or months and ordinarily makes the decision about the procedure him or herself. For a patient in a nursing home or home care who has an irreversible condition, such as after a serious stroke not showing recovery, or in states of advanced dementia, we have a separate brochure, “PEG tube in the hospital patient,” which should be consulted.
How do I prepare for my procedure?
In the days before your surgery, tell your surgeon about any medications you take, including herbal supplements and over-the-counter medications. You may be asked to stop taking aspirin or other medications that thin your blood and may increase bleeding. These are other ways to prepare: Tell your doctor if you or someone in your family has any history of reaction to anesthesia. The stomach is kept empty of food for 8 or more hours, and empty of simple liquids for at least 2 hours. Ask your endoscopist if you should take your regular medications with a small sip of water. Wear loose, comfortable clothing on the day of surgery. If you are going home after the procedure, someone else must drive you home and stay with you during the early recovery period.
How is the procedure performed?
At the endoscopy unit a nurse will start an IV, a dose of antibiotic is usually given and either the endoscopist physician or an anesthesia professional will administer strong sedation. An endoscope (a flexible tube with a camera and a light on the end) is passed through the mouth, throat and esophagus into the stomach. The physician then makes a small incision (cut) in the skin of the abdomen over the stomach and the feeding tube is then guided into the stomach and the tube is secured into position so it can’t easily move downstream or come out too easily.
What can I expect after my procedure?
Immediately following the placement of a feeding tube, you will be watched closely for any complications, such as bleeding or unexpected pain. The PEG tube will be secured to your abdomen with tape. You should expect to see some slight seepage around the PEG tube for the first 24 to 48 hours. A sterile gauze dressing will be placed around the incision. Your home care nurse will teach how to change the dressing as needed. Once the dressing has been removed and the area has healed, be sure to wash the area daily with soap and water.
What are the risks involved with the procedure?
Possible complications include infection of the puncture site (as in any kind of surgery,) dislodgement of the tube with leakage of the liquid diet that is fed through the tube into the abdomen, and clogging of the tube, which can usually be remedied without replacing the tube. Bleeding sometimes occurs either immediately after the procedure, sometimes delayed. If the stomach doesn’t function well, vomiting may occur. People who are in very frail condition from their underlying disorders that prevent eating are already at great risk of pneumonia and heart irregularities, and any sedated surgical procedure has risks of these events.
What are my alternatives to this procedure?
There are alternatives to PEG feeding tubes. A nasogastric (NG) feeding tube can be passed through the nose into the stomach for feeding, and is secured to the face with tape. Long-term use of these tubes can cause nose and sinus irritation, throat discomfort and sometimes infection. These tubes also have a tendency to be accidentally pulled out. Sometimes though an NG feeding tube is preferred and lower risk, particularly if the condition treated may be of short duration or risks of the PEG too high. Also, a surgeon can place a feeding tube into the stomach in the operating room or a radiologist can place a feeding tube into the stomach in the fluoroscopy (X-Ray) suite. Similar procedures can be done to place feeding tubes into the jejunum (intestine downstream from the stomach) as well, depending on the clinical scenario.
Where will the PEG be performed?
PEG is performed in a hospital or outpatient surgical facility. It is not necessary to perform a percutaneous endoscopic gastrostomy in an operating room.
How long does the PEG take?
The procedure takes between 20 to 40 minutes to complete.