What is percutaneous endoscopic gastrostomy (PEG)?

​It is the procedure of placing a feeding catheter in the stomach through a small incision in the anterior abdominal wall, with the help of an endoscope. The procedure is intended to feed patients who cannot receive food by mouth (e.g. post-stroke patients who experience food aspiration into the lung when receiving food by mouth).

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What are the indications for PEG placement?

​PEG is applied to patients who cannot consume sufficient oral food to meet their daily nutritional needs. The most common reasons for placement of percutaneous gastrostomy are neurological conditions associated with "poor" swallowing, e.g. patients after stroke, multiple sclerosis, Parkinson's disease and patients with cancer of the oro-nasopharyngeal cavity or esophagus. The feeding tube may also be required in patients with malignancy within the abdomen which causes compression and obstruction of the stomach or small intestine.

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What happens during PEG placement?

Before the operation, the doctor performs a gastroscopy to ensure the correct positioning of the gastrostomy inside the stomach. An incision is then made in the anterior abdominal wall through which a feeding tube is inserted into the stomach or small intestine. 

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Preparing for the examination

The doctor will take your medical history and look at your tests. Don't forget to mention any respiratory, cardiac, neurological or psychiatric problems, allergies and any medications you are taking. Mention if you have prostate, glaucoma, diabetes and if you are taking aspirin, antiplatelet or blood thinners.

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BEFORE THE EXAMINATION

It is very important that the stomach is empty so that we can detect even small lesions, and to avoid complications during the examination

The patient must fast for at least 6 hours before the test without eating any solid food. Water or other clear liquids (coffee/tea/juice; no milk) may be consumed up to 2 hours before the examination.

• If you are taking anticoagulant medicines do not take your anticoagulant on the day of the test.
• If you are taking medication for diabetes mellitus, do not take any medication while you are fasting before the test. It is a good idea to measure your blood sugar 30 minutes before you come in. If it is too low you can take a candy or drink some juice to avoid any hypoglycaemia.
• All other medicines can be taken with a little water up to 2 hours before the test.

During the operation

• ​Your doctor will then perform a gastroscopy to locate the point of passage of the gastrostomy into the stomach
• An incision is made in the anterior wall of the abdomen through which the gastrostomy tube is passed and fixed to the wall of the abdomen. Sterile gauze is placed between the skin and the gastrostomy tube support to avoid direct contact of the feeding tube with the skin and thus reduce the risk of complications
• The procedure takes 30-45 minutes

After the operation

• You should be watched carefully for the next 24 hours for possible complications
• An adult will need to accompany you home after the operation. Do not drive or operate any machinery for the next 24 hours.
• You may notice a small leakage of fluid through the skin (at the site of the gastrostomy) over the next 24-48 hours
• You should change the gauze daily to avoid infections
• Clean the stoma area on the skin daily with soap and water and then apply a sterile cream
• A dietician should inform you when to start tube feeding and how to continue feeding through the tube via ready-to-eat foods that are pushed through the tube
• For a few days you will feel itching and pain at the entry point of the gastrostomy through the skin 
• Feeding tubes do not need to be changed frequently and can last for several months
• If you have any problems with the tube, tell your doctor

Are there any complications from PEG gastrostomy placement?

​Sometimes it is possible to have complications from the procedure. The most common complications are leakage of fluids or food from the incision site into the skin, , pain, minor bleeding, infection at the skin incision site. Tell your doctor if you notice any complications. More serious complications are rare but can happen. These include major bleeding, peritonitis (infection within the abdomen) and damage to the bowel or nearby organs. Late complications include 'buried bumber' syndrome in which the gastrostomy valve which is located inside the stomach is buried within the wall of the abdomen. This can be prevented by avoiding excessive pressure on the valve.