A PEG tube is removed by a healthcare provider, typically in a clinic or outpatient setting, and the procedure itself takes only a few minutes. There are three recognized methods: external traction (pulling the tube out through the abdominal wall), endoscopic removal using a scope passed through the throat, and the “cut and push” method where the tube is cut at skin level and the internal piece is allowed to pass naturally through the digestive tract. Which method your provider uses depends on the type of internal bumper holding the tube in place inside your stomach.
How the Tube Is Actually Removed
The most common approach for tubes with a collapsible internal bumper is external traction. Your provider cuts the tube near the skin to deflate the internal disc or balloon, then firmly pulls the tube straight out through the abdominal wall. The whole process is quick, though it can involve a sharp pulling sensation that lasts a few seconds. A dry dressing is placed over the site immediately after.
Some PEG tubes have a rigid internal bumper that can’t collapse enough to pass safely through the stoma tract. In those cases, your provider will use an endoscope (a thin, flexible camera passed through your mouth) to retrieve the bumper from inside the stomach. The European Society of Parenteral and Enteral Nutrition recommends endoscopic removal as the standard approach, though traction removal is widely used when the tube design allows it.
The third option, the “cut and push” method, involves cutting the tube at the skin and pushing the internal bumper down into the stomach so it passes through the intestines on its own. In a review of this technique, 48 patients successfully expelled the internal piece, confirmed by X-ray. One patient needed a follow-up scope because the bumper got stuck at the outlet of the stomach. This method is less commonly used but remains an option when other approaches aren’t practical.
What Makes You Eligible for Removal
Your medical team will evaluate whether you can sustain adequate nutrition by mouth before scheduling removal. This usually means you’ve been tolerating oral meals consistently and maintaining your weight without relying on tube feedings. Your provider may also want to confirm that any underlying swallowing problems have resolved or improved enough that you won’t need the tube again shortly after it comes out.
Preparing for the Procedure
You’ll be asked not to eat, drink, or use the PEG tube for about two hours before your appointment. Essential medications can still be taken with small sips of water. No sedation is typically needed for traction removal, which is one reason it’s often done in a clinic rather than a procedure suite.
How the Site Heals
Once the tube is out, the hole in your stomach wall begins closing on its own. About 94% of gastrostomy sites seal within 24 hours. During that initial period, some leakage of stomach fluid through the opening is completely normal. This is why a firm gauze dressing is placed over the site right away.
In some cases, the tract takes longer to close. Leakage can persist for several weeks, causing skin irritation around the site. Your provider may prescribe a medication to reduce stomach acid production, which cuts down on the amount of fluid leaking through the tract and helps it seal faster. A follow-up visit is typically scheduled for two to four weeks after removal. By that point, there should be little to no drainage.
Caring for the Site at Home
Daily wound care is straightforward. Wash the site once a day with soap and water, rinse it, and pat it dry. Then place a tightly folded 4×4 gauze pad over the opening and tape it firmly in place. Any time the gauze becomes fully wet from drainage, swap it out: rinse the site with water, dry it, and apply a fresh gauze.
If the skin around the site gets pink or sore from stomach fluid contact, apply a layer of zinc oxide ointment (the same cream used for diaper rash) to protect the area. You don’t need to scrub it all off each day. When you do want to fully remove it, soften the ointment with baby oil or cooking oil, then wipe clean and wash.
Eating and Drinking After Removal
Wait at least two hours after removal before eating or drinking anything. This brief fast reduces how much stomach fluid leaks through the fresh opening during the period when it’s most vulnerable. After those two hours, you can resume your normal diet.
Possible Complications
Most removals go smoothly, but a few problems can occur. The most notable is a persistent gastrocutaneous fistula, where the tract between the stomach and skin doesn’t close and continues leaking for more than a month. In a study of 331 patients who had PEG tubes removed, 19 (about 5.7%) developed this complication. Of those, nearly two-thirds responded to medical therapy over four to eight weeks. The remaining patients needed either an endoscopic procedure to close the opening or, in three cases, surgery.
A retained internal bumper is another rare complication. This happens when the piece of the tube inside your stomach gets stuck and can’t be pulled out or passed naturally. If this occurs, a follow-up procedure or minor surgery may be needed to retrieve it.
Warning Signs to Watch For
Some drainage from the site during the first 48 to 72 hours is expected. Contact your healthcare provider if you notice any of the following:
- Fever of 100.4°F (38°C) or higher
- Increasing redness, tenderness, or swelling around the site
- Unusual or worsening drainage beyond the first few days, especially if it changes color or smell
If a PEG tube falls out accidentally before a planned removal, that’s a different situation. The stoma can begin closing very quickly, so it’s important to get medical attention within 24 hours to either replace the tube or manage the opening.