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Percutaneous Endoscopic Gastrostomy (PEG)


Definition

A surgical procedure to place a tube inside of the stomach.

Involvement

Stomach, skin, parts of the abdominal wall.

Reasons for Procedure

A gastrostomy tube is used to:

  • Feed a person who has difficulty sucking or swallowing
  • Drain the stomach of accumulated acid and fluids in a person with a blockage between the stomach and the small intestine

Risk Factors for Complications during the Procedure

  • Stress
  • Obesity
  • Smoking
  • Excess consumption of alcohol
  • Use of narcotics or other mind-altering drugs
  • Use of certain prescription medications, including muscle relaxants and sedatives, anti-hypertensives, insulin, beta-adrenergic blockers, cortisone
  • Prior surgeries that involved or may have made positioning the abdomen difficult (such as a gastrectomy)

What to Expect Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • Medical history
  • Review of medications
  • Blood test
  • Urine test
  • X-rays of gastrointestinal tract
  • Endoscopic examination of stomach – an endoscope is a fiberoptic tube attached to a viewing device

In the days leading up to your procedure:

  • Do not take aspirin, aspirin-containing products, or anti-inflammatory drugs for one week before the procedure after discussing this with your
  • Do not eat or drink for at least eight hours before the procedure
  • Arrange for a ride to and from the procedure

Just before the procedure:

  • You'll remove eyeglasses and dentures
  • You'll remove your clothes and put on a hospital gown

During Procedure:

  • IV medications
  • Sedative
  • Anesthesia
  • An endoscope will be inserted into your stomach through your mouth

Anesthesia – Local, usually a lidocaine spray; IV pain reliever and a sedative
Description of the Procedure - This procedure is usually done by a surgeon and a gastroenterologist working together. An endoscope (a long, thin fiberoptic tube with a tiny video camera on its end) is inserted through the mouth and down the esophagus into the stomach. The endoscopic camera is used to produce pictures of the inside of the stomach on a video monitor so that the proper spot for insertion of the PEG feeding tube can be located.

The surgeon inserts a needle into the stomach at the spot where the PEG tube will be located. Using the endoscope, the gastroenterologist 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 surgeon then pulls the wire back out from the abdomen, which 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.

After Procedure – The PEG tube is secured to your abdomen with tape
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, which often feels like a pulled muscle. Your doctor can prescribe pain medications to relieve this discomfort.

Possible Complications:
PEG complications are relatively rare. Complications include:

  • Wound infection
  • PEG tube dislodgment or malfunction
  • Aspiration – accidental sucking into the airways of fluid, food, or any foreign material
  • Bowel perforation – a hole in the wall of the intestine
  • Gastrocolic fistula – an abnormal opening connecting the stomach and the colon
  • Peritonitis – inflammation of the lining of the abdomen
  • Septicemia – an infection affecting the entire body, caused by the spread of microorganisms and their toxins through the circulating blood
  • Leakage at the tube insertion site
  • Abdominal bloating
  • Nausea
  • Diarrhea
  • Irritation or infection of skin around the tube

Average Hospital Stay: 0–1 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 and 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 help 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 necessary, but avoid taking aspirin or aspirin-containing products
  • To promote healing, resume normal activities as quickly as possible

Outcome

This procedure results in the placement of a workable alternative feeding site.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Headaches, muscle aches, dizziness, fever, or general ill feeling
  • Nausea, constipation, or abdominal swelling
  • Vomiting

 


 

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