What is Percutaneous Endoscopic Gastrostomy (PEG)?
Percutaneous Endoscopic Gastrostomy means a connection that is purposely made with the aid of an endoscope between stomach and the abdominal wall to allow a feeding tube to be placed through the abdominal wall into the stomach. The commonest reason for a PEG tube is when patients are unable to drink or swallow enough to be able to maintain adequate nutritional intake. This can be due to a stroke, other neurological disorders, surgery or issues with the oesophagus. Sometimes it is placed prior to a course of radiotherapy to the head and neck or oesophageal region as patients may have difficulty swallowing due to radiation effects.
Specifically designed supplements can be pumped into the PEG tube to allow adequate caloric intake. Medications can also be administered via the PEG tube.
The decision to proceed to a PEG is not straight forward in many cases especially when the patient is not able to make the decision for themselves such as after a significant stroke where the patient’s judgement and awareness is impaired. The key question to discuss amongst family members when they are involved with the decision making is whether the PEG will improve the quality of life for the patient.
How is the PEG inserted?
Blood thinners may have to be stopped prior to the PEG insertion to reduce the risk of bleeding. Antibiotics are usually administered at the time of the procedure and therefore allergies should be discussed beforehand.
A patient is fasted from solids for at least 6 hours before the procedure. Clear fluids may be consumed up to 2 hours before the procedure but the doctor will confirm whether this is appropriate in each individual case.
The procedure is performed under sedation. A mouth guard is placed between the teeth to protect the teeth. An endoscope is inserted from the mouth into the stomach to select a suitable position for the PEG tube.
Local anaesthetic will then be injected into the skin of the abdominal wall at the selected site. A small cut is then made after the skin is adequately anaesthetised. The PEG tube is then inserted through the stomach and will exit at this site. The procedure takes roughly 20 minutes.
What happens after the procedure?
The patient will recover from the sedation usually in the recovery area. Some patients will require an overnight stay. If you are discharged, you must not drive, travel unaccompanied, operate machinery, sign legal documents or stay alone on the day of the procedure.
Bathing with mild soap can start 24 hours after the PEG insertion. Make sure the area under the PEG bolster is dry after bathing. Keep this area clean and dry all the time.
The PEG tube should fit snugly against the skin but not cause any pressure. Rotate the PEG tube a full 360 degrees each day.
Will the PEG tube be used for feeding?
Water will be given through the tube usually 6 hours after insertion. If this is tolerated, medications and feeds may be commenced. A dietician would have advised on the most suitable liquid feed which can be given continuously through a pump or intermittently though a large syringe or a flask.
You may be allowed to eat and drink orally as well but this will be discussed beforehand with your doctor as it depends on the individual circumstances.
What are the risks of a PEG tube?
This is a safe procedure but there are always some inherent risks with all procedures. There is a greater risk of complications if the patient is malnourished. Minor complications occur in 10% of people which can include wound ooze, infection or raised scar tissue formation at the PEG site called granulation tissue. Less commonly leakage around the tube, bleeding or accidental tube dislodgement can occur. Serious complications are rare but can include accidental puncture of another organ or even a remote chance of death from the procedure or its complications.
Care must be taken with the feeds to minimise the chance of refluxing into the lungs which can lead to chest infections called ‘aspiration pneumonia’. The feeds also need to be correctly stored to prevent bacterial contamination.
Is the procedure painful?
There maybe some discomfort in the throat for a day or two after the procedure. The site of the PEG insertion into the abdominal wall may be sore for up to a week. You will be given analgesia for discharge. If the prescribed analgesia is not sufficient, please contact your doctor to check the PEG.
How long des a PEG tube last for?
The silicone tubing can last up to a year but will eventually need to be replaced as they deteriorate and may become brittle or split. They require flushing after each feed and medication dosage as the tube can become blocked.
The tube may also occasionally fall out. It is important to have another tube placed in as soon as possible to prevent the opening from closing over. Any problems should be referred to the endoscopy unit where the PEG tube was inserted. Sometimes a PEG can be replaced without another endoscopy but it may be required to repeat the endoscopy under different circumstances.
If a PEG is no longer required, it can simply be removed and the hole will close over naturally.
More information can be obtained at the Gastrostomy Information and Support Service (GISS) on 02 9843 2011 or www.scopevic.org.au/giss
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