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Preparing for Percutaneous Endoscopic Gastrostomy (PEG)

Picture this: You’re walking down the street when you pass a pizzeria. The smell of freshly made pizza makes you stop and look in the shop window. Your stomach growls at the sight of all that warm dough and melted cheese — reminding you that you haven’t eaten since breakfast.

Next thing you know, you’re sitting down to eat a slice of that fresh-from-the-oven pizza. You take a bite, chew, and swallow. With each delicious bite, you send food toward the stomach for digestion.

Digestion allows your body to break food down into the nutrients and calories you need to function. For most people, chewing and swallowing are the first steps for this to take place. But when that isn’t an option, your body will need to receive the food a different way.

Unfortunately, many health issues — such as stroke or Parkinson’s disease — can make the simple task of eating by mouth difficult. Without enough food, you could lose unhealthy amounts of weight and develop serious illnesses from not getting the nutrients you need.

One way to avoid this when eating by mouth isn’t an option is through the placement of a feeding tube. This can be done in a low-risk procedure called percutaneous endoscopic gastrostomy (PEG).

What is PEG?

PEG refers to both the feeding tube itself (PEG tube) and the procedure to insert the tube (PEG procedure):

During the PEG procedure, a gastroenterologist (digestive health specialist) uses an endoscope –– a long, thin, flexible tube with a camera and light attached to the end –– to guide the PEG tube down your esophagus and into the stomach. One end of the PEG tube will be secured in the stomach and the other end will come out through a small incision in your upper abdomen (belly).

A nurse, pharmacist, registered dietitian, or physician who specializes in nutrition will then determine your nutritional needs and choose a formula that meets those needs. They will teach you how to inject the formula into the tube so you can get the nutrition you need without using your mouth or esophagus.

Who Needs a PEG Tube?

Your provider may recommend a PEG tube for you if you are unable to eat enough food by mouth to receive the nutrients your body needs to function — as long as your stomach is still able to absorb and digest food properly. For instance, you may need a PEG tube if you have trouble swallowing.

Swallowing is a complex process that involves coordinating eating with breathing. In a healthy person, your airway sits right behind the esophagus and they share a pathway at your throat. When you are swallowing food down your throat, your voice box closes tightly to prevent food from getting into your airway.

At the same time, your breathing stops. When the food has passed down into the esophagus and stomach, your breathing starts again. If you have difficulty swallowing, this coordination may be impaired. Your voice box might not receive the signal usually given by the swallowing reflex, so it could remain open instead of closing off when food passes toward the throat. This can cause you to breathe food into your lungs.

Conditions that may cause difficulty with swallowing — and could lead to needing a PEG tube — include:

  • Gastreoesophageal reflux disease (GERD): GERD is a more serious form of acid reflux disease. It causes acid to rise back up into the esophagus from the stomach. This can cause the esophagus to narrow.
  • Eosinophilic esophagitis: This is a chronic disease that causes the esophagus to become inflamed, which can narrow the esophagus.
  • Esophageal and/or mouth cancers: These diseases can keep you from being able to swallow because tumors can block the throat.
  • Stroke: Stroke can make it hard to control the throat muscles needed to swallow.
  • Amyotrophic lateral sclerosis (ALS): ALS is a central nervous system disease that can make swallowing difficult by weakening or stiffening the muscles in your throat.
  • Parkinson’s’ Disease: This is a central nervous system disorder that can affect movement, including swallowing.

Depending on your condition, a PEG tube may be just a temporary solution for you to stay healthy. As you recover and regain the ability to swallow, you may eventually be able to have the tube removed and return to normal eating by mouth. However, if your swallowing issue is a result of neurological damage (damage to the brain, spine, or nerves), you may need to rely on a PEG tube permanently.

Getting Prepared For the PEG Procedure

Before your PEG procedure, your health care team will review your medical history, and discuss the procedure itself as well as which nutrition formula is best for you.

Let your providers know beforehand if you have a heart condition, diabetes, allergies to any medications, or allergies to any types of anesthesia. These conditions can increase your risk for complications. Your provider may need to take extra steps to prepare you in advance to avoid complications such as bleeding and infections. For example, they may have you:

  • Adjust your insulin dose on the day of the procedure if you have diabetes
  • Change your blood thinner a few days ahead of the procedure if you have heart disease
  • Stop taking anti-inflammatory drugs or aspirin a few days before the procedure

Follow your provider’s instructions and do not make any adjustments without consulting them first.

Do not eat or drink anything for 8 hours before the procedure. An empty stomach is important for two reasons:

  1. It can help your provider see your stomach better and find the best place for the tube.
  2. When you are sedated, your muscle reflexes stop working. Any food or liquid in your stomach could flow back up and you could breathe them into your lungs.

Since PEG placement involves sedation, you will need to make arrangements for someone to drive you home after the procedure. You may also need someone to stay at home with you after you’re discharged from the hospital.

On the Day of the Procedure

    PEG Explained Step-By-Step

  1. You will be given a sedative and pain relievers through an IV, and local anesthesia (numbing medicine) will be applied to the area of your belly where the tube will be placed.
  2. Your provider will insert the tube with the help of an endoscope into your mouth.
  3. Your provider will use the endoscope to look at the lining of your stomach to find the best location to insert the tube through the stomach wall.
  4. The PEG tube will be inserted into the stomach wall on one end and out of your abdomen through a small incision on the other end.
  5. Your provider will make sure the PEG tube is securely placed.

The PEG procedure typically takes around 15 to 20 minutes to complete. This is usually an outpatient procedure, meaning you can go home the same day.

After the procedure is done, the tube site will be covered by a bandage to prevent infections. After a day or two, this will be removed. Once it’s removed, you should keep the PEG tube site clean and dry.

Although this procedure is generally safe, there are a few possible complications, including:

  • Pain at the PEG site
  • Infection of the PEG site
  • Inhaling nutrition formula or stomach acid into the lungs
  • Bleeding at the PEG tube site

If you experience any signs of a complication — especially if your PEG tube site is bleeding and leaking food or stomach acid — contact your gastroenterologist and go to the emergency room immediately.

Living With a PEG Tube

A PEG tube shouldn’t get in the way of most daily life activities. You can still go out with friends and loved ones like you used to. The major difference is the way your body takes in nutrients.

When it’s time for a feeding or taking medication, you will need to open the plug on the tube that’s on the surface of your abdomen. Don’t forget to close it when you’re done, since the plug prevents stomach contents from leaking out.

You may be able to eat some food or liquids by mouth after receiving a PEG tube — but only do so if you provider says it is okay.

Using Your PEG Tube

Before using your tube, wash your hands to prevent bacteria from getting into your stomach and causing an infection. Make sure you are sitting upright. An upright posture can prevent reflux and avoid food being breathed into lungs.

You should slowly infuse the formula to decrease the risk of complications such as bloating, cramping, or vomiting. After the infusion, make sure you stay upright for 30 to 60 minutes. You may need these feedings 4 to 6 times a day in order to meet your daily nutrition needs.

If you are on any medications, talk to your provider about how to take these medications. You may be able to crush and dissolve pills in water that can be injected into the tube. Or you may need to switch to a liquid form of the medication. Follow your provider’s instructions on this, and don’t infuse any medication without their permission.

If the medications can be infused, make sure to flush the tube with water each time to prevent clogging.

Caring for Your PEG Tube

Your health care team will show you how to use and care for the PEG tube properly. This may involve:

  • Connecting the end of your PEG tube to a syringe or a feeding drip bag that will hang on a rack while you are feeding.
  • Using a pump: A pump can free your hands while you are receiving the formula. It can also infuse the formula at different speeds. You will need to connect your PEG tube to the tube extending from the pump and insert the tube from the feeding bag into the pump. When it’s turned on, the liquid food will flow through the pump and go into your stomach at the speed you set.

You will need to clean the tube site (the area around the incision) once a day with diluted soap water and clean water. Then, gently dry the area and keep it dry.

The tube can get clogged if it is not cleaned carefully. Your provider will let you know how much water to use to flush it before and after each feeding.

Replacing Your PEG Tube

PEG tubes don’t last forever. Some tubes last about a year, though others wear out sooner. If you notice pits, bumps, or leaks on the side of the tube, it might mean that it’s time for a new tube. Don’t replace the tube by yourself. It should be done by a provider. They can easily remove the old tube and insert a new one.

If your tube falls out, call your provider immediately. You will need a new tube right away because the opening on your stomach can begin to close — meaning you could end up needing another procedure to create a new opening.

Supporting a Loved One Who Needs a PEG Tube

If you are helping care for a loved one who has a PEG tube, you may be able to assist them by hooking the tube to a pump or injecting the formula. Be sure to ask your loved one’s care team to demonstrate proper use before assisting.

Why Choose Stormont Vail

Located in Topeka, Kansas, Stormont Vail Health is a community-driven organization. It offers close to home care and with limited travel requirements, it will be easier for you to get the care you need in a community you trust.

In 2018, Stormont Vail achieved Magnet designation for a third time. Magnet designation is one of the highest awards in nursing excellence and high-quality patient care. Only 9% of US hospitals have earned this recognition. The Joint Commission — with more than 50 years of accrediting hospitals in high quality standards — has also accredited Stormont Vail Hospital.

The Cotton O’Neil Digestive Health Center has a dedicated Endoscopy Center for procedures like PEG. You can meet with providers, be tested in our Endoscopy Center, and learn how to manage digestive health conditions – all under one roof.

We are committed to treating the entire person, not just the condition. Your digestive health team and primary care provider will work closely with one another to make sure you have a seamless care experience.

Next Steps

Make an Appointment

  • To make an appointment at the Digestive Health Center, call (785) 270-4800.

See a Primary Care Provider

  • Call (785) 270-4440 to schedule an appointment with your Stormont Vail primary care provider.
  • Not a Stormont Vail patient? Call (785) 270-4440 to set up your first appointment with one of our primary care providers.