A Percutaneous Endoscopic Gastrostomy (PEG) tube is a medical device that provides a way to deliver nutrition, fluids, and medications directly into the stomach. It serves as an alternative feeding method for individuals who are unable to consume enough by mouth.
Specific Anatomical Placement
A PEG tube is placed directly into the stomach through a small opening created in the abdominal wall. This placement bypasses the mouth and esophagus, allowing direct access to the digestive system. The external portion of the tube remains on the skin of the abdomen, while the internal part resides within the stomach.
The tube is secured in place by both internal and external retention devices. Inside the stomach, a small internal bumper or bolster holds the tube against the stomach wall, preventing it from being pulled out. On the outside, a disc or external bumper rests against the skin of the abdomen, which also helps to keep the tube from moving inward.
Procedure for Insertion
The insertion of a PEG tube is a minimally invasive endoscopic procedure. Before the procedure, patients receive sedation and local anesthesia. An endoscope, a thin, flexible tube with a camera, is guided through the mouth, down the esophagus, and into the stomach.
Once the endoscope is in the stomach, the optimal site for tube placement on the abdominal wall is identified through transillumination, where light from the endoscope shines through the abdominal skin, and by finger indentation. A small incision is then made in the skin, and a needle and guidewire are passed through this incision into the stomach. The guidewire is retrieved by the endoscope, the PEG tube attached, and then pulled through the esophagus, stomach, and out through the abdominal incision, seating the internal bumper against the stomach wall. The external retention device is then positioned to secure the tube on the outside, leaving a small space between it and the skin.
Reasons for PEG Tube Placement
PEG tube placement is indicated for various medical conditions that prevent adequate oral intake or safe swallowing. One common reason is dysphagia, or difficulty swallowing, often resulting from neurological disorders such as stroke, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), or dementia. These conditions can impair the muscle control needed for safe eating and drinking, increasing the risk of aspiration.
The tube is also used for individuals with head and neck cancers, where tumors or treatments like radiation therapy can make swallowing painful or impossible. Additionally, severe malnutrition or other conditions that prevent a person from consuming enough nutrients by mouth can necessitate PEG tube placement. It offers a long-term solution for enteral feeding when oral methods are not feasible.
Initial Post-Placement Care
Immediately after PEG tube placement, some tenderness and drainage around the insertion site are common. A dressing may be applied, which is removed within 24 to 48 hours. Cleaning the site regularly with mild soap and water or saline solution is important to prevent infection and promote healing.
Initial feeding through the PEG tube begins slowly, starting with small amounts of water within a few hours of insertion. The volume and type of feeds are gradually increased as tolerated, progressing to full formula feeding within 24 hours. Monitoring the site for any signs of infection, such as increased redness, swelling, severe pain, or excessive leakage, is important, and medical attention should be sought if these occur. The external bumper should be positioned about 1 cm from the skin to allow for cleaning and prevent pressure injuries.