A percutaneous endoscopic gastrostomy (PEG) is a safe and effective way to provide food, liquids and medications directly into the stomach. The procedure is done for patients who are having trouble swallowing.

What happens during the percutaneous endoscopic gastrostomy (PEG) procedure?

During the procedure, the doctor places an endoscope into the patient's mouth. The endoscope is then advanced through the esophagus (the "food pipe" leading from the patient's mouth into his stomach) and into the stomach.

The endoscope is used to ensure the correct positioning of the PEG tube (also called a feeding tube) in the patient's stomach. The PEG tube rests in the stomach and comes out through the skin of the abdomen.

The percutaneous endoscopic gastrostomy (PEG) tube provides nutrition for patients who are having trouble swallowing. The internal bumper rests in the stomach, and the adapter comes out through the skin of the abdomen.

Let the doctor know if the patient is having a lung or heart condition, a bleeding tendency or if he is allergic to any medications.

Medications

• If the patient is having diabetes and use insulin, he may need to adjust the dosage of insulin the day of the test. The primary physician will help the patient with this adjustment.
• Tell the primary physician if the patient is taking blood thinning medications such as Coumadin (warfarin), Persantine (dipyridamole) or Ticlid (ticlopidine hydrochloride). The primary physician may prescribe an alternate method for thinning the patient's blood before the procedure.
• Within 1 week before the procedure, do not take aspirin, products containing aspirin or anti-inflammatory drugs (such as ibuprofen including Advil or Motrin Naprosyn or Indocin)

Transportation

The patient will need to bring a responsible adult to accompany him after the procedure. The patient should not drive or operate machinery for 24 hours. The medication given during the procedure may cause drowsiness, making it unsafe for the patient to drive or operate machinery.

On the day of the procedure

The patient may need to stay overnight in the hospital after the procedure, so please pack any personal items that he may need.

The patient will meet with a physician who will explain the procedure in detail, including possible complications and side effects. The physician will also answer any questions the patient may have.

During the procedure

• The patient will be asked to wear a hospital gown and to remove his eye glasses and/or dentures, if he is having them.
• The procedure is performed by a physician with experience in the PEG procedure.
• The patient is given a pain reliever and sedative intravenously (in the patient's vein). The patient will feel relaxed and drowsy.
• The patient is given a local anesthetic (pain-relieving medication) at the site where the PEG tube is placed.
• The endoscopy physician inserts an endoscope through the patient's mouth and into his stomach. The endoscope does not interfere with the patient's breathing.
• Through the endoscope, the physician will view the stomach lining to determine the PEG tube insertion site.
• A small incision is made in the abdominal wall where the PEG tube will exit.
• The procedure lasts from 30 to 45 minutes.

After the procedure

• The patient will be observed closely for any complications.
• The PEG tube will be secured to the patient's abdomen with tape.
• A responsible adult must accompany the patient after the procedure. Do not drive or operate machinery for 24 hours.
• The patient should expect to see some drainage around the PEG tube for the first 24 to 48 hours.
• A sterile gauze dressing will be placed around the incision. The nurse will change the dressing as needed.
• Once the dressing has been removed and the area has healed, be sure to wash the area daily with soap and water.
• A dietitian will teach the patient how to use and care for his PEG tube, and he will be started on enteral tube feeding (feeding directly through the gastrointestinal tract).
• The dietitian will help the patient's choose a commercially prepared formula for the tube feeding.
• For a couple of days, the patient may have minor soreness in his abdomen where the PEG tube was inserted. This will feel like a pulled muscle. The patient will receive medication to help relieve this pain the first few days after the procedure.
• The amount of care needed for the PEG tube varies among patients. Generally, PEG tubes do not need to be replaced for several months, and may even function well for 2 or 3 years.
• If the patient is having difficulty with the PEG tube, please call the health care provider.