Percutaneous Endoscopic Gastrostomy

What you should know

  • Percutaneous endoscopic gastrostomy (PEG) is a procedure to place a soft, plastic feeding tube into your stomach. You may need a PEG tube if you cannot get enough nutrition eating food by mouth. Without enough nutrition, you may lose too much weight and become dehydrated (loss of body fluids). Formula (liquid food) can be given through the tube to give your body the nutrition it needs. The tube may also be used for decompressing (removing air and fluid) your stomach. Your caregiver uses an incision (cut) and an endoscope to insert the PEG tube into your stomach. An endoscope is a small, bendable tube with a light and camera on its tip. One end of the PEG tube is inside your stomach, and the other end is secured on your abdomen. Your abdomen is a cavity (space) that holds many organs, such as your stomach, intestines (bowels), and liver.



  • You may have trouble eating if you have cancer in your mouth or esophagus (food pipe). Medical conditions, such as a stroke or other brain and nerve problems, may cause trouble swallowing. You may also have trouble swallowing from an injury or a serious (very bad) burn. You may need a PEG tube for decompression if your stomach does not empty on its own. You may need your PEG tube for a short time, or for the rest of your life. A PEG tube used for decompression may stop nausea (upset stomach) and vomiting (throwing up). A PEG tube may prevent loss of body weight and dehydration. A PEG tube may allow your body to get the nutrition it needs to function.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

  • The anesthesia medicine used for your procedure may cause your blood pressure to drop too low. During your procedure, the endoscope may damage your esophagus, stomach, or nearby organs and tissues. Damage to your organs or tissues may cause bleeding in, and behind, your abdominal cavity. If you have esophageal cancer, the endoscope may spread cancer cells to the PEG tube site. During or after the procedure, liquid from your stomach may enter your lungs, causing a lung infection. Excess air or gas may collect in your abdominal cavity. After your procedure, you may have bruising around your stoma, and your stoma may be painful. The skin around your PEG tube may break open or blister, and tissue may grow over your tube.

  • Your PEG tube may become buried in your skin or move out of place. Formula used for feeding may leak out of your stoma. Your PEG tube may become blocked and it may crack, break, or leak. Your stomach may have trouble emptying into your bowel. A fistula (abnormal tissue opening) may form between your skin and your stomach or your colon. Your wound may become infected, and you may get an abscess (pus pocket) near your wound. You may get an infection in your abdomen or nearby tissues, or you may get a life-threatening blood infection.

  • If you do not get a PEG tube for decompression, your stomach may not empty properly. Liquids from your stomach may enter your lungs and cause a lung infection. If you do not have a PEG feeding tube placed, you may not get enough nutrition for your body. Not eating can cause dehydration. You may continue or start to lose more weight than you should. Poor nutrition and lost body weight can be life-threatening and you may die. Talk with your caregiver if you have questions or concerns about your condition, treatment, or care.

Getting Ready

Before your procedure:

  • Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.

  • Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.

  • You may need blood taken for tests. Ask your caregiver for more information about any other tests you may need. Write down the date, time, and location of each test.

  • Ask your caregiver what supplies you may need at home to care for your PEG tube after the procedure.

The night before your procedure:

  • Ask caregivers about directions for eating and drinking.

The day of your procedure:

  • Write down the correct date, time, and location of your procedure.

  • You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.

  • Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.

  • Antibiotics may be given to help prevent an infection caused by germs called bacteria.

  • An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell caregivers if you or anyone in your family has had a problem with anesthesia in the past.

Treatment

What will happen:

  • You will be taken to the procedure room. You may be given medicine in your IV to help you relax or make you sleepy. The endoscope will be put in your mouth, moved down your esophagus, and into your stomach. The light on the end of the endoscope may be seen through your abdomen. The light will help your caregiver find the best place on your abdomen to insert the PEG tube. Your stomach may be filled with air or gas to help your caregiver better see inside your stomach. Local anesthesia medicine may be given as a shot to numb the procedure area. A small cut is made in your abdomen. A needle with a catheter (tube) over it will be put through your skin and into your stomach.

  • A wire will be threaded through the catheter and grabbed through the end of the endoscope. The wire will be pulled through the endoscope and out of your mouth. A caregiver will attach the PEG tube to the wire. The PEG tube will be pulled back through the endoscope and into your stomach. Inside your stomach, one end of the tube will be held in place with a bumper (attached plastic). The other end of the PEG tube will be pulled out through the cut in your abdomen. The opening in your abdomen where your PEG tube comes through is called a stoma. The endoscope and wire are removed, and the tube is secured on your abdomen with a bumper. Your caregiver may insert the endoscope again to check the placement of your PEG tube.

  • Your caregiver may not use an endoscope if you have a blockage or cancer in your throat or esophagus. Your caregiver will place the PEG tube directly into your stomach through a cut in your abdomen. This may also be done if your caregiver cannot see the endoscope light to choose the best PEG site. Your caregiver will use an ultrasound as a guide during the procedure. An ultrasound is a test that uses sound waves to show the inside of your body on a screen. The tube is held in place with a small inflated (blown up) balloon on the inside of your stomach.

After your procedure:

  • You will be taken to a room to rest until you are fully awake and any numbness is gone. Caregivers will monitor your vital signs including your temperature, heartbeat, breathing, and blood pressure. Do not get out of bed until your caregiver says it is okay. When caregivers see that you are not having any problems, you may be able to go home. You may get your first PEG tube feeding before leaving the hospital. If you are staying in the hospital, you will be taken to your room.

  • Before leaving the hospital, caregivers will teach you how to use your PEG tube. If someone helps you with your care, the person should be included in any PEG tube teaching. You may also be seen by a nutrition caregiver to talk about your tube feedings.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

  • You cannot make it to your procedure.

  • You have a fever.

  • Your symptoms, such as trouble swallowing, nausea, vomiting, or diarrhea get worse.

Seek Care Immediately if

  • You have new trouble breathing.

  • You have severe (very bad) stomach pains.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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