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Percutaneous Endoscopic Gastrostomy (PEG)

Percutaneous endoscopic gastrostomy is the procedure in which a feeding tube is placed through the abdominal wall and into the stomach using a thin, flexible camera called an endoscope. The percutaneous endoscopic gastrostomy tube allows nutrition to be administered directly into the stomach, bypassing the mouth and esophagus.

Indications
The percutaneous endoscopic gastrostomy tube is usually placed in patients who may have had a nasogastric tube for a long period and found it to be uncomfortable and prone to dislodging. (The nasogastric tube runs through the nose, down the esophagus, and into the stomach.) A nasogastric tube can also cause ulcers where it places pressure on sensitive skin and tissue as well as sinus infections. Furthermore, the nasogastric tube can cause reflux, which can lead to aspiration and lung infection. So in patients who require tube feeding, the percutaneous endoscopic gastrostomy tube is a good choice.
 
Types of Percutaneous Endoscopic Gastrostomy Tubes
The percutaneous endoscopic gastrostomy tube is a silicone tube measuring just 0.5 centimeters in diameter and approximately 20-30 centimeters in length. The part that is in the stomach resembles the hat of a mushroom or a balloon. The part of the tube that extends from the abdomen will be marked with numbers to ensure appropriate placement. An external bumper keeps the tube from slipping into the stomach or becoming dislodged.
There are three types of percutaneous endoscopic gastrostomy tubes:
  1. The non-balloon percutaneous endoscopic gastrostomy tube has a catheter tip that looks like the hat of a mushroom to prevent it from dislodging. There is a bumper on the tube where it extends from the abdomen to keep it from slipping into the stomach and the tube is marked with numbers to ensure its proper position. A cap is attached to the end of the catheter to close it.
  2. The balloon percutaneous endoscopic gastrostomy tube has a catheter tip in the stomach that resembles a balloon to prevent it from dislodging. There is a bumper on the tube where it extends from the abdomen to keep it from slipping into the stomach and the tube is marked with numbers to ensure its proper position. To inflate the balloon, 7-10 milliliters of water are usually administered or an amount recommended by the doctor. The tube has 2-3 openings and caps to allow for the administration of food, medication, and water for the balloon.
  3. The skin-level percutaneous endoscopic gastrostomy tube can be separated. The catheter tip may resemble a mushroom hat or a balloon, depending on its function. The external bumper is flush to the skin of the abdomen.
Remark: Types 2 and 3 are tubes that require inspection of the water level in the balloon every 1-2 weeks because if the water level is too low, the tube can become dislodged when the patient coughs or sneezes.
 
  1. The patient receives the nutrition they need, improving their health.
  2. It is easier to use and more convenient than a nasogastric tube.
  3. Low rate of complications, including pneumonia due to aspiration and nasal inflammation/infection.
The possible complications of placing the percutaneous endoscopic gastrostomy tube include pain at the site, leakage of stomach contents through the opening around the tube, malfunction of the tube, infection, and/or bleeding. Please see your doctor right away if you experience any of these as they can signal more serious complications.

Using the Percutaneous Endoscopic Gastrostomy Tube
Food is administered through the tube using a large syringe, a bag with tubing that connects to the percutaneous endoscopic gastrostomy tube, or other drip/feeding equipment. Your medical team will provide detailed instructions on how your tube and feeding process will work. The placement of the percutaneous endoscopic gastrostomy tube doesn’t mean you cannot eat and drink by mouth. The limitations of this will depend on your condition and will be explained to you by your team.
 
Common Problems
  1. The percutaneous endoscopic gastrostomy tube may become dirty, usually due to highly concentrated food and insufficient water being used to flush the tube after the feed.
  2. The percutaneous endoscopic gastrostomy tube may leak or expand if it’s been used for a long time or if the food is too hot.
  3. Food may not be able to be administered through the tube.
  4. The percutaneous endoscopic gastrostomy tube can become dislodged. If this happens, cover the opening with a sterile gauze or bandage and return to the hospital immediately.
 
Removal
The percutaneous endoscopic gastrostomy tube can be used for 6-12 months, but long-term use may cause issues and require the tube be replaced. This can usually be done without any anesthesia, depending on the patient’s condition and the doctor’s decision. The doctor can simply pull out the tube and replace it, if needed, or not, if the tube is no longer required. Once removed, the opening in the abdomen will heal quickly. This is also why it’s important that if the tube is replaced, it has to be done carefully. Depending on how long you will need the tube, your doctor will schedule appointments for it to be replaced, usually every 4-6 months.

 
 
  • This procedure does not affect air travel.
  • Travelers to Thailand should plan to stay in the country for at least seven days after the procedure.
Please discuss your specific scenario with your doctor.
 
What if the procedure is not done?
Without the percutaneous endoscopic gastrostomy tube, you may not receive the necessary nutrition your body requires. If you have a nasogastric tube, there may be the risk of complications, such as pneumonia due to aspiration and inflammation or infection of the nasal cavity.
 
  1. Nasogastric tube travels through the nose, down the esophagus, and into the stomach. If you have a nasogastric tube, always make sure it’s in the right position by drawing up stomach contents before administering food. If nothing is pulled up, the position of the tube should be rechecked to ensure it is in the stomach.
  2. Nasojejunal tube travels through the nose and into the small intestine. This may be a preferred feeding method for the unconscious patient with gastric reflux or delayed gastric emptying. The nasojejunal tube is very small.

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