PEG tube placement is often required for patients unable to meet adequate caloric intake due to a variety of medical conditions. These include neurologic diseases with inadequate swallow function, aspiration, obstructive tumors of the head/neck/esophagus, or severe esophageal dysmotility. Occasionally a PEG can be placed to decompress the stomach if there is a malignant bowel obstruction in a patient that is not a surgical candidate. Alternatives to a PEG are surgically placed gastrostomy tubes or gastrostomy tubes placed by interventional radiologists.
- Do not eat or drink after midnight.
What is a PEG?
A PEG is a procedure performed under anesthesia and involves a typical upper GI endoscopy. After the endoscopic evaluation, a flexible tube made of polyurethane or silicon is placed endoscopically through the stomach out of the abdominal wall. This typically is positioned in the left upper quadrant of the abdomen but this can depend on a patient's anatomy. The tube allows direct feeding of liquid nutrition, medication and fluids directly to the stomach, bypassing the mouth. To place the tube, a small incision is made in the abdominal wall. The tube is typically soft and can be coiled when not in use and taped down to the abdominal wall. PEG tubes can be replaced as they degrade typically after about 6 months. Removal and replacement of old gastrostomy tubes can be performed in an office visit and doesn't require anesthesia. The procedure typically will take about 15 minutes and can be performed on an outpatient basis. Risks of initial PEG placement include the anesthesia, bleeding and infection at the gastrostomy site.
Which patients are candidates for a PEG?
This can be difficult to answer as there are medical indications, contraindications, and ethical considerations. PEG tubes are typically placed if a patient will be in need of feeding through the GI tract for at least one month. If the feeding support is for a lesser duration, alternative routes such as nasogastric/nasoenteral tubes or parenteral (IV) feedings are typically preferred. Once a PEG is placed it needs to be left in place and should not be removed for about one month. If the tube is not required after the first month, this can be removed by the gastroenterologist in an office setting. Contraindications to PEG placement include ascites, gastric or peritoneal tumors, bleeding disorders, and patients with survival not expected to exceed at least one month. PEG tubes are not typically placed for dementia as they have not been shown to prolong life.