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Percutaneous Endoscopic Gastrostomy (PEG)

Gastroenterology Hepatology

Percutaneous Endoscopic Gastrostomy (PEG) is a medical procedure that uses endoscopic techniques to insert a plastic tube directly into the stomach through the skin, providing long-term nutritional support for patients unable to eat normally.

Indications

Percutaneous Endoscopic Gastrostomy (PEG) is primarily indicated for patients who cannot eat orally due to swallowing difficulties. Common conditions include:

Swallowing disorders caused by neurological diseases (e.g., stroke, Parkinson’s disease)
Dysphagia following head and neck tumors or surgery
Long-term swallowing difficulties due to other causes

Procedure

Preoperative Preparation	Insert a nasogastric tube to aspirate gastric contents and insufflate air during the procedure to expand the stomach. Administer intravenous medications to suppress gastric motility. Perform sterile preparation of the upper left abdomen and apply local anesthesia.
Procedure	An endoscope examines the stomach and identifies an appropriate puncture site. Secure the stomach to the abdominal wall using a gastric fixation device to facilitate puncture. Insert a puncture needle near the fixation device, dilate the tract, and insert a plastic feeding tube into the stomach.
Postoperative Care	Monitor vital signs (e.g., blood pressure, pulse) after the procedure. Initiate feeding through the tube after 1-2 days. Remove the gastric fixation device after 7-10 days. Replace the feeding tube every 3 to 6 months. Ensure the feeding tube remains securely in place and does not shift.

Potential Complications

Feeding Tube Malfunction (~23%)
– Blockage or dislodgement of the tube.
Peritubular Leakage (~2%)
– Leakage of gastric contents around the tube site.
Superficial Infection (~1.6%)
– Localized infection at the insertion site.
Bleeding
– May occur at the puncture site or internally.
Gastrointestinal Perforation – Accidental perforation of the stomach or intestines.

Despite these risks, Percutaneous Endoscopic Gastrostomy (PEG) remains a safe and effective procedure, with a success rate exceeding 90%.

Caring Recommendations

Proper postoperative care and regular follow-up can significantly reduce the risk of complications, ensuring that the patient receives continuous nutritional support.

Keep the area around the stoma clean to prevent infection.
Regularly replace the feeding tube, usually every 3-6 months.
Ensure the feeding tube is securely fixed to avoid displacement.
When feeding, the patient should maintain a semi-upright position and remain in this position for about 60 minutes afterward to prevent reflux.
For bedridden patients, elevate the head by at least 30 degrees.
Before feeding, check if the feeding tube is patent and measure the residual stomach contents.
After feeding or administering medication, flush the feeding tube with 30-50 ml of water.
Avoid using medications not fully dissolved in water to prevent tube blockage.

FAQ

Generally, local anesthesia and sedatives are used during the procedure so the patient should not experience severe pain. After the procedure, mild discomfort or pain may occur, but this can be managed with medication.

The duration for which a PEG feeding tube remains in place depends on the patient's condition. Some individuals may require long-term use, while others may have the tube removed after a few months. Regular medical evaluations help determine whether the tube needs to be replaced or removed.

Patients should keep the area around the tube clean and dry, avoiding excessive pulling or pressure on the tube. Following medical care instructions is essential to ensure the tube remains uncontaminated and free from complications.

PEG can deliver liquid nutrition, medications, and other nutritional components to help maintain the patient's nutritional status. This is especially critical for individuals who cannot eat or swallow normally.