A Percutaneous Endoscopic Gastrostomy (PEG) tube provides nutrition, fluids, and medication directly into the stomach when a person cannot safely swallow or consume enough by mouth. It offers a long-term solution for nutritional support by bypassing the upper digestive tract. The tube is inserted through a small opening created in the abdominal skin, leading straight into the stomach.
Defining the Percutaneous Endoscopic Gastrostomy Tube
The term Percutaneous Endoscopic Gastrostomy precisely describes the placement method of this feeding device. The word “percutaneous” means “through the skin,” while “endoscopic” refers to the use of an endoscope, a flexible tube with a camera, to guide the placement. “Gastrostomy” refers to the creation of a new opening into the stomach.
The PEG tube is typically made of silicone or polyurethane. On the outside of the abdomen, an external bumper rests against the skin to prevent the tube from sliding inward. The tube includes a port, often a Y-port, which serves as the access point for administering liquid formula, water, and medications.
Inside the stomach, an internal retention device, such as a soft bumper or a balloon, holds the tube securely against the stomach wall. The small opening where the tube passes through the abdominal wall is called the stoma.
Medical Reasons for PEG Tube Placement
A PEG tube is indicated for individuals requiring long-term enteral nutrition who possess a functioning gastrointestinal tract. The most common reason for placement is severe dysphagia (difficulty swallowing), which prevents adequate oral intake and increases aspiration pneumonia risk. This often results from neurological conditions, such as stroke, Parkinson’s disease, or Amyotrophic Lateral Sclerosis (ALS).
Head and neck cancer is another indication, as tumors or treatment side effects can make eating impossible. Chronic malnutrition or severe wasting (e.g., associated with cystic fibrosis or advanced HIV/AIDS) may also necessitate a PEG tube for nutritional stability. The tube can also be used for gastric decompression in patients with abdominal malignancies causing obstruction.
Placement involves assessing the patient’s prognosis and goals of care. While effective for nutritional delivery, it is not recommended for advanced dementia, as studies suggest it may not improve quality of life or extend survival. The PEG tube provides a safer alternative to a nasogastric tube for prolonged feeding.
The Insertion Procedure and Immediate Post-Op Recovery
The PEG tube insertion is a minimally invasive procedure typically performed in an endoscopy suite or operating room. The patient receives conscious sedation, local anesthetic, and prophylactic antibiotics. An endoscope is passed into the stomach to visualize the lining.
The endoscopist uses the light from the endoscope to identify the optimal exit point on the abdominal wall. After the area is numbed, a small incision is made, and a needle is passed into the stomach cavity. A guidewire is threaded through the needle and grasped by the endoscope, which pulls the wire back up through the mouth.
The PEG tube is attached to the guidewire and pulled down through the mouth, esophagus, and stomach, exiting the incision in the abdomen. This “pull” method is the most common technique for placement. The internal bumper is seated against the stomach wall, and the external bumper is secured against the skin.
Immediately following the procedure, the patient is monitored for 24 to 48 hours for complications like bleeding or excessive pain. Soreness and mild cramping are common but typically resolve quickly. Initial tube feedings often begin with clear fluids six to 24 hours after placement, once the site has stabilized.
Daily Life and Long-Term Tube Care
Living with a PEG tube requires daily care to prevent infection and ensure functionality. The stoma site must be cleaned daily with mild soap and water, then gently patted dry. Keeping the skin clean and dry prevents irritation and infection. Avoid placing dressings or gauze directly between the external bumper and the skin unless directed by a healthcare professional, as this can lead to “buried bumper syndrome.”
To prevent clogging, the tube must be flushed with 20 to 30 milliliters of water before and after every feeding or medication administration. Medications should be liquid or thoroughly crushed and mixed with water before administration. Feeding can be done using a pump for continuous infusion or via a syringe for a bolus feed, depending on the patient’s tolerance and regimen.
Patients and caregivers must rotate the tube once daily to prevent the internal bumper from adhering to the stomach wall. Although a PEG tube can last for months or years, it eventually needs replacement. Replacement is usually a simple, non-surgical procedure performed in a clinic, as the tract between the stomach and the skin has matured.
Minor complications, such as leakage around the stoma or granulation tissue, are common and manageable with proper care. However, signs of fever, severe pain, or if the tube accidentally falls out, require immediate medical attention. If the tube dislodges, the stoma tract can close quickly, necessitating urgent replacement within hours.