Percutaneous Endoscopic Gastrostomy (PEG) is a medical procedure that places a flexible feeding tube directly into the stomach through the abdominal wall. This tube provides a pathway for delivering nutrition, fluids, and medication, bypassing the mouth and esophagus. This ensures sustenance reaches the gastrointestinal tract without relying on the patient’s ability to swallow.
This method of enteral feeding is considered a long-term solution for nutritional support. It is a common procedure performed endoscopically, making it less invasive than traditional surgery. The PEG tube connects the external environment to the stomach, allowing for consistent delivery of formula.
When is PEG Feeding Required
The decision to place a PEG tube is made when a patient cannot safely swallow or ingest enough nutrition orally for an extended period. The inability to swallow, known as dysphagia, is a frequent indication, often resulting from neurological events like a stroke, progressive diseases such as Amyotrophic Lateral Sclerosis (ALS), or head and neck cancers. These conditions create a high risk of aspiration, where food or liquid enters the lungs.
PEG is chosen over a short-term Nasogastric (NG) tube when nutritional support is anticipated for longer than four weeks. An NG tube, which passes through the nose and down the throat, is reserved for temporary situations or acute illness. PEG tubes are more comfortable for patients requiring months or years of support because they do not rest in the nasal passages or throat, and they carry a lower risk of accidental dislodgement.
Placing the Feeding Tube
The PEG tube is placed using a minimally invasive technique involving an endoscope, which is a flexible tube with a light and camera. The patient receives mild sedation for comfort, and the procedure usually takes less than 30 minutes. An antibiotic is administered beforehand to minimize the risk of infection at the insertion site.
A gastroenterologist guides the endoscope down the esophagus and into the stomach. The stomach is inflated with air to bring the stomach wall closer to the abdominal wall. A bright light from the endoscope identifies the ideal external puncture location through transillumination, and a small incision is then made in the skin.
Using the “pull” method, a needle and wire are passed through the incision into the stomach. The endoscope retrieves the wire and pulls it up through the mouth. The PEG tube is attached to the wire and pulled back down the esophagus, through the stomach, and out of the abdominal incision. The tube is secured internally by a bumper against the stomach wall and externally by a fixation device against the skin.
Managing the PEG Tube Daily
Successful long-term management relies on consistent daily care to prevent complications like infection and clogging. The skin around the tube site, known as the stoma, requires gentle cleaning at least once a day with mild soap and water. It is important to clean beneath the external fixation device and thoroughly pat the area dry, as moisture can lead to skin irritation.
To maintain the health of the tract and prevent the internal bumper from adhering to the stomach lining, the tube must be rotated a quarter turn daily. Caregivers should push the tube inward and pull it outward a small amount each day, ensuring the external fixation device is not too tight. The tube’s position should be checked daily by noting the centimeter marking visible at the stoma site.
Flushing the tube with water, often 30 milliliters, is required before and after every use, including each medication administration and feeding session. This action clears residual formula or crushed medication, reducing the chance of a blockage. Medications must be in liquid form or finely crushed and mixed with water, as whole pills will obstruct the narrow tube lumen.
Feeding can be administered in two ways: bolus or continuous. Bolus feeding involves delivering a set volume of formula several times a day using a large syringe, mimicking regular meals. Continuous feeding uses an electronic pump to deliver formula slowly over a period of 12 to 24 hours. The choice of method depends on the patient’s tolerance and overall medical plan.
Recognizing Potential Issues
While PEG tubes are safe, recognizing signs of potential issues is important to prevent complications. Infection at the insertion site is the most common problem, signaled by increased pain, warmth, swelling, redness, or a foul-smelling discharge. Persistent leakage of stomach contents or formula around the tube onto the skin can cause irritation and requires prompt attention.
If the tube accidentally comes out, it is necessary to seek immediate medical help, as the tract connecting the stomach to the abdominal wall can begin to close within hours. Displacement or migration of the tube can be detected if the centimeter marking visible at the skin changes noticeably. A clogged tube resists flushing with warm water and should be reported to a healthcare provider if simple irrigation techniques fail to clear the obstruction.