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Percutaneous Endoscopic Gastrostomy (PEG) Explained

Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure to place a feeding tube through the abdominal wall directly into the stomach for long-term nutritional support.

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Things worth knowing about "Percutaneous endoscopic gastrostomy"

Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure to place a feeding tube through the abdominal wall directly into the stomach for long-term nutritional support.

What is Percutaneous Endoscopic Gastrostomy?

Percutaneous endoscopic gastrostomy (commonly abbreviated as PEG) is a medical procedure in which a flexible feeding tube is placed through the abdominal wall directly into the stomach using an endoscope (a thin, flexible camera instrument). The term “percutaneous” means “through the skin,” while “endoscopic” refers to the use of the endoscope that guides the procedure from within. PEG is used to provide long-term nutritional support for patients who are unable to eat or swallow adequately.

Indications: When is a PEG Used?

A PEG tube is considered when a patient cannot maintain adequate oral nutrition for an extended period. Common indications include:

Neurological conditions such as stroke, amyotrophic lateral sclerosis (ALS), or advanced dementia with swallowing difficulties
Head and neck cancers or tumors of the esophagus affecting swallowing
Severe dysphagia (swallowing disorders) from various causes
Prolonged unconsciousness or disorders of consciousness
Severe malnutrition or significant unintentional weight loss in chronic illness

The decision to place a PEG tube always involves careful medical and ethical evaluation, and is made in consultation with the patient or their legal representative.

How is a PEG Placed?

The procedure is typically performed under light sedation and local anesthesia, either on an outpatient or inpatient basis. The main steps are:

An endoscope is passed through the mouth into the stomach.
The physician uses the endoscope to illuminate and identify the optimal placement site on the abdominal wall.
A small incision is made through the skin at that site.
A hollow needle is inserted through the abdominal wall into the stomach, and the PEG tube is threaded through and secured using a pull-through technique.
The tube is fixed externally with a retention plate to prevent displacement.

The entire procedure generally takes between 15 and 30 minutes.

Feeding Through a PEG Tube

Once the tube is in place, specially formulated liquid enteral feeds can be delivered directly into the stomach. These formulas are nutritionally complete, containing all required macronutrients, vitamins, and minerals. Feeding can be administered continuously via a pump or in bolus doses (given in portions throughout the day), depending on the patient's needs and tolerance.

Care and Potential Complications

Regular care of the insertion site is essential to minimize the risk of complications. Possible complications include:

Local infection at the insertion site (the most common complication)
Leakage around the tube
Granulation tissue (overgrowth of tissue around the wound)
Tube blockage due to insufficient flushing
Less common complications such as peritonitis (abdominal infection), bleeding, or tube misplacement

Regular medical follow-up and proper tube care by trained healthcare professionals or caregivers are essential for minimizing complications and ensuring effective nutritional support.

Tube Replacement and Removal

PEG tubes can remain in place for several months to years. When necessary, they can be exchanged or replaced with a lower-profile button device for greater comfort and discretion. If the patient regains the ability to eat and swallow adequately, the tube can be removed. The small wound typically closes on its own after removal.

References

Loser C, Wolters S, Folsch UR. Enteral long-term nutrition via percutaneous endoscopic gastrostomy (PEG) in 210 patients. A four-year prospective study. Digestive Diseases and Sciences, 1998; 43(11): 2549-2557.
Arends J et al. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 2017; 36(1): 11-48.
Rahnemai-Azar AA et al. Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World Journal of Gastroenterology, 2014; 20(24): 7739-7751.

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