PEG - FEEDING TUBE
What is a PEG?
PEG stands for percutaneous endoscopic gastrostomy, a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach. PEG allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and esophagus.
How is the PEG performed?
You will be deeply sedated by an Anesthesiologist and Dr. Ravi will use a lighted flexible tube called an endoscope into the stomach through the mouth to guide the creation of a small opening through the skin of the upper abdomen and directly into the stomach. This procedure allows the placement of a feeding tube into the stomach. An antibiotic is given by vein prior to the procedure. Patients can usually go be fed via the newly placed tube the next day. The video below includes an illustration of the "pull-method" Dr. Ravi usually uses.
Who can benefit from a PEG?
Patients who have difficulty swallowing, problems with their appetite or an inability to take adequate nutrition through the mouth can benefit from this procedure.
How should I care for the PEG tube?
A dressing will be placed on the PEG site following the procedure. This dressing is usually removed after a few days. Dr. Ravi suggests applying and antibiotic ointment - eg Neosporin-Polymixin-Bacitracin ("Triple Antibiotic") ointment to the site where the tube enters the skin for 4 to 5 days. After that you should clean the site once a day with diluted soap and water and keep the site dry between cleansings. No special dressing or covering is needed.
How are feedings given? Can I still eat and drink?
Specialized liquid nutrition, as well as fluids, are given through the PEG tube. If the PEG tube is placed because of swallowing difficulty (e.g., after a stroke), there will still be restrictions on oral intake. Although some PEG patients may continue to eat or drink after the procedure, please ask Dr. Ravi if this is advisable.
Are there complications from PEG placement?
Complications can occur with the PEG placement. These include pain at the PEG site, leakage of stomach contents around the tube site, and dislodgment or malfunction of the tube. If the tube falls out or is pulled out after the opening has healed - this can take several weeks - the tube can usually be easily replaced. If the tube falls out - or is pulled out before the opening has healed well, an urgent operation may be needed. Other possible complications include infection of the PEG site, aspiration (inhalation of gastric contents into the lungs), bleeding and perforation (an unwanted hole in the bowel wall). There is also the risk that a loop of bowel may be punctured as the PEG is placed. While every attempt is made to decrease this risk, these cannot be completely avoided. The decision to place the PEG will therefore depend on weighing risks vs benefits.
How long do these tubes last? How are they removed?
PEG tubes can last for months or years. However, because they can break down or become clogged over extended periods of time, they might need to be replaced. PEG sites close quickly once the tube is removed, so accidental dislodgment might require immediate attention.
The following video may help understanding this procedure as well.