Percutaneous Endoscopic Gastrostomy (PEG)

Do not take aspirin, aspirin-containing products, or anti-inflammatory drugs for one week before the procedure.Do not eat or drink for at least eight hours before the procedure.Arrange for a ride to and from the hospital. Just before the procedure: Remove eyeglasses and dentures. AnesthesiaLocal, usually a lidocaine spray, intravenous (IV) pain reliever, and sedative will be given for anesthesia. Description of the ProcedureThis procedure is done by a surgeon and a gastroenterologist working together. An endoscope is inserted through the mouth, down the esophagus, and into the stomach. A camera on the endoscope takes pictures of the inside of the stomach. The pictures are shown on a video monitor so that the doctor can find the right spot to insert the PEG feeding tube.The doctor inserts a needle into the stomach at the spot where the PEG tube will be located. Using the endoscope, the doctor locates the end of the needle inside the body, and encircles it with a wire snare. A thin wire is then passed from the outside of the body, through this needle, and into the abdomen. This wire is then grasped with the snare and pulled out through the mouth. Now, there is a thin wire entering the front of the abdomen into the stomach and continuing upward and out the mouth. The PEG feeding tube is attached to this wire outside of the mouth. The doctor then pulls the wire back out from the abdomen, This pulls the PEG down into the body through the mouth and esophagus. The tube is pulled until the tip of the PEG comes out of the incision in the stomach. There is a soft, round "bumper" attached to the portion of the PEG that remains inside the body. This bumper secures the tube on the inside of the body. The outer portion of the tube is secured with a bumper as well. Sterile gauze is placed around the incision site.

Percutaneous Endoscopic Gastrostomy Procedure 2008 Nucleus Medical Art, Inc. After ProcedureThe PEG tube is taped to your abdomen. How Long Will It Take?30-45 minutes Will It Hurt?Anesthesia prevents pain during the procedure, although you may feel some discomfort. For a couple of days after the procedure, you may have minor pain and soreness at the incision site. This may feel like a pulled muscle. Your doctor can prescribe pain medications to relieve this discomfort. Possible Complications PEG complications are relatively rare. Complications include: Wound infectionPEG tube dislodgment or malfunctionAspirationaccidental sucking into the airways of fluid, food, or any foreign materialBowel perforationa hole in the wall of the intestineGastrocolic fistulaan abnormal opening connecting the stomach and the colonPeritonitisinflammation of the lining of the abdomen Septicemiaan infection affecting the entire body, caused by the spread of microorganisms and their toxins through the circulating blood Leakage at the tube insertion siteAbdominal bloatingNauseaDiarrheaIrritation or infection of skin around the tube Average Hospital StayOne day Postoperative Care When resting in bed, keep legs elevated and moving to avoid deep vein blood clots. Change the sterile gauze pads around the incision site regularly. Learn to feed yourself properly through the PEG feeding tube: You'll receive fluids through an IV for a day or two. Then you'll be advanced to clear liquids through the gastrostomy tube, and then to a formula.A dietitian will teach you how to use your PEG tube. She will also teach you how to choose an appropriate tube-feeding formula.Remain upright for 30-60 minutes after eating.Do not smoke.Learn the proper care of your PEG tube.Wash PEG tube and skin around tube regularly to avoid infection.Learn how to empty the stomach through the tube.Learn how to recognize and handle such problems as a blocked tube or a tube that falls out of place.Tape tube site when not in use to prevent dislodging.Do not take prescription pain medication for more than seven days. After this point, take non-prescription pain relievers (such as ibuprofen) as needed, but avoid taking aspirin or aspirin-containing products.To promote healing, resume normal activities as quickly as possible. OutcomeThis procedure allows placement of a workable alternative feeding site.

Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision siteHeadaches, muscle aches, dizziness, fever, or general ill feelingNausea, constipation, or abdominal swellingVomiting RESOURCES: American Society for Gastrointestinal Endoscopyhttp://www.asge.org/ Oral Cancer Foundationhttp://www.oralcancerfoundation.org/ CANADIAN RESOURCES: Dietitians of Canadahttp://www.dietitians.ca/ University Health Networkhttp://www.uhn.ca/ References: Avitsland TL, Kristensen C, Emblem R, et al. Percutaneous endoscopic gastrostomy in children: a safe technique with major symptom relief and high parental satisfaction. J Pediatr Gastroenterol Nutr. 2006;43:624-628. Duszak R Jr. Percuaneous gastrostomy and jejunostomy. eMedicine website. Updated March 26, 2003. Available at: http://www.emedicine.com. Accessed June 13, 2008. Ljungdahl M, Sundbom M. Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial. Surg Endos. 2006;20:1248-1251. Overviewpercutaneous endoscopic gastrostomy (PEG). Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/Percutaneous_Endoscopic_Gastrostomy_PEG/hic_Percutaneous_Endoscopic_Gastrostomy_PEG.aspx. Accessed June 13, 2008.

Patient information. American Society for Gastrointestinal Endoscopy website. Available at: http://www.asge.org/PatientInfoDefault.aspx?id=364. Accessed June 13, 2008. Last reviewed November 2007 by Daus Mahnke, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.