A percutaneous endoscopic gastrostomy (PEG) tube is a medical device that provides a means of delivering nutrition, fluids, and medication directly into the stomach when a person cannot swallow safely or adequately. This method of feeding, known as enteral nutrition, supports patients who require nutritional assistance. While often seen as a temporary measure, a PEG tube can also be a long-term solution, making its permanence dependent on the underlying medical condition. Placement is typically decided when feeding support is expected for an extended period, usually exceeding 30 days.
Defining the Percutaneous Endoscopic Gastrostomy Tube
A PEG tube is a flexible tube placed through the abdominal wall and directly into the stomach to bypass the mouth and esophagus. The term “percutaneous endoscopic gastrostomy” describes the placement method: through the skin, guided by an endoscope, and into the stomach. The tube is held in place by an internal bumper or flange inside the stomach and an external retention disc against the skin of the abdomen. This device is an alternative to a traditional surgical gastrostomy.
The primary purpose of the PEG tube is to ensure adequate nutritional and hydration status for patients with a functional gastrointestinal tract. Conditions like severe dysphagia (difficulty swallowing) due to a stroke, head and neck cancer, or neurological disorders often necessitate its use. It provides a reliable route for administering specialized liquid nutrition formulas and medications, which helps prevent malnutrition and aspiration pneumonia.
Factors Determining Short-Term Versus Long-Term Use
The duration for which a PEG tube remains in place is dictated entirely by the patient’s medical prognosis and the reason for its insertion. In many cases, the tube is intended for short-term use, functioning as a bridge to recovery. Patients recovering from acute illnesses, trauma, or temporary obstructions may only need the tube until normal swallowing function returns, which can take several weeks or months.
If the underlying condition is expected to resolve, the PEG tube is considered temporary, often needed for less than a year. However, the tube becomes a long-term fixture when the medical issue causing the inability to swallow is chronic or progressive. This includes advanced stages of neurodegenerative diseases, such as amyotrophic lateral sclerosis (ALS), where the difficulty in swallowing is permanent.
The medical team continually assesses the patient’s ability to safely consume enough nutrition orally. For conditions like severe stroke, if swallowing function has not returned after several weeks, a PEG tube is preferred over a temporary nasogastric tube for longer-term support. In these situations, the PEG tube may be permanent, lasting for years and requiring periodic replacement due to general wear.
The Insertion and Discontinuation Processes
The placement of a PEG tube is a minimally invasive procedure, usually performed under mild sedation without the need for general anesthesia. A flexible endoscope is passed through the mouth and down into the stomach, allowing the physician to visualize the stomach lining. The physician identifies a suitable spot on the abdominal wall and uses the endoscope’s guidance to make a small incision, through which the tube is passed directly into the stomach.
The most common technique involves threading a wire through the incision and pulling the PEG tube down the esophagus and into the stomach, where its internal bumper is secured against the stomach wall. The entire procedure typically takes less than 30 minutes. Once the need for the feeding tube ends, the discontinuation process is straightforward and does not always require a second endoscopy.
For a standard PEG tube, removal involves either pulling the internal bumper through the external stoma tract or cutting the tube and allowing the internal portion to pass naturally through the digestive system. After removal, the small stoma, or opening, usually closes on its own within a few days, leaving only a minimal scar.
Routine Care and Living with a PEG Tube
Daily care of a PEG tube focuses on maintaining the cleanliness of the insertion site and ensuring the tube remains functional. The skin around the stoma needs to be cleaned daily with mild soap and water to prevent irritation and infection. Gently rotating the tube daily, once the initial healing period is over, prevents the internal bumper from adhering to the stomach wall, a complication known as buried bumper syndrome.
Preventing clogs is a major part of routine maintenance. This is accomplished by flushing the tube with water before and after each use of formula or medication. A typical flush involves using 30 milliliters of water to clear the tube of any residual material that could harden and block the channel. Monitoring the external markings on the tube is also necessary to ensure it has not migrated or become dislodged.
Recognizing potential issues is important for safety. Signs of a possible infection, such as increasing redness, swelling, significant pain, or thick discharge around the site, require immediate medical attention. Tube dislodgement or accidental removal is an urgent situation, as the stoma tract can begin to close rapidly, necessitating prompt reinsertion by a medical professional.