A PEG is a feeding tube which passes through the abdominal wall directly into the stomach, so that nutrition can be provided without swallowing, or in some cases to supplement ordinary food. The PEG tube can be connected to a mechanical pump to provide feeds continuously or a syringe can be use to receive feeds at intervals.
Why is a PEG required?
PEGs are used in patients who are unable to swallow or who are unable to eat enough and need long term artificial feeding. Common causes include patients with stroke (CVA), head injuries, neurological diseases such as multiple sclerosis or motor neuronal disease, surgery to the head or neck, or patients undergoing chemotherapy. In some cases PEGs are used to give extra nutrition (or supplements) to people who can still eat, such as patients with cystic fibrosis.
How is the PEG inserted?
PEG placement involves an examination of the stomach with an endoscope. A PEG feeding tube is then passed into the stomach through a small opening on the wall of the abdomen. Attached to the tube there is a small plastic disc which lies close to the skin to prevent movement of the tube and a small clamp or plastic cap which keep the tube closed when feeding is not taking place. The procedure requires a minor operation and is usually performed in the outpatient setting with an intravenous sedative injection. Some patients, however, may require hospitalization and/or general anesthesia. For a few hours after the procedure you will probably feel drowsy and may have a sore throat where the endoscope has been passed. There may also be some discomfort at the incision site on your abdomen. You will be instructed on how to clean the incision site, when to start feeding after insertion of the tube, and how to administer feedings through the PEG feeding tube.
What are the Risks?
The risks of the PEG placement are similar to those with standard upper endoscopy. These include the risk of bleeding, bowel perforation and adverse reaction to the sedative medications. In addition, with the abdominal incision there is a risk of accidental puncture of nearby organs as well as infection of the skin (cellulitis). Prophylactic intravenous antibiotics will be administered with the procedure as a preventative measure for potential infection. The overall risk of a complication occurring is estimated as being 1/1000 patients. Although the risk of death is extremely rare, this too is a potential complication of the procedure.
What are the Alternatives?
Feeding tubes can also be placed percutaneously (across the abdominal wall) either by the radiologists (using X-ray guidance) or by the surgeons. On occasion, if the PEG feeding tube cannot be placed safely by the endoscopic approach, the patient will be referred for one of these other options.
A feeding tube can also be placed non-invasively via the nose and directed into the stomach or small intestine. Although this can be performed with minimal risk, the tube can accidentally be pulled out or fall out, and often can be uncomfortable if the tube is to remain for a prolonged period of time.
Note: The information in this section is provided as a supplement to information discussed with your healthcare provider. It is not intended to serve as a complete description of a particular topic or substitute for a clinic visit.
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