A PEG (or Percutaneous Endoscopic Gastrostomy as it may also be called) is a small feeding tube which is inserted directly into the stomach so that you can have feed (a liquid that contains all the essential nutrients that you need on a daily basis), fluid and medication as your swallow may be affected.
The PEG tube can be used to give feed, fluids and medications if you experience problems with swallowing. You may also eat and drink in the normal way with the PEG in place if you are able to do so.
Your doctor has recommended that you have a PEG tube fitted before your treatment as you are likely to have some problems with drinking, eating and taking medications after starting your treatment.
You may not need to start using your PEG immediately but it is best that the PEG is placed before you start treatment. You may need to rely on your PEG for all food and fluids during your treatment or you may need it to give you additional nutrition if you are still able to take a little food and fluid by mouth.
As an alternative the feeding tube can be inserted through the stomach wall using an xray technique. This is called a RIG (Radiological Inserted Gastrostomy). This method is not available at Blackpool Victoria Hospital. Your Specialist has recommended that you have a PEG tube inserted directly into your stomach after inserting stitches to fix the stomach wall to the abdomen.
The insertion of a PEG tube is a safe procedure but sometimes risks can occur. Minor complications occur in about 20% of patients. The most common are oozing from the wound, formation of granulation tissue or infection in the wound. Less commonly leakage from around the tube may happen. Rarely injury to nearby organs, perforation or bleeding can occur.
You will be admitted to Blackpool Victoria Hospital on the day of the procedure. Consent will be obtained.
You will also have some blood tests taken to check that your blood is clotting normally. Occasionally you may need to have Vitamin K given before the procedure to improve the clotting of your blood. This would be arranged by the ward staff if it is needed. You will need to have nothing to eat or drink for four hours before the procedure and you will receive an antibiotic injection into a vein in your arm before you have the procedure. This is to reduce the risk of infection.
The PEG tube is inserted using an endoscope in the Gastro Unit. You will be given a sedative to help you relax. Some people experience some discomfort but it is not a very painful procedure. A flexible tube with a tiny camera is passed through your mouth and into your stomach, which will be inflated with some air and a local anaesthetic will be injected into the skin. Two sutures are placed in your abdominal wall and a tiny cut is made in the skin of the abdomen usually below the ribs towards the middle of your abdomen. The PEG tube will be placed into the stomach with part of the tube coming out through the small cut in the skin, the tube is held in place with a small balloon.
The procedure takes approximately 10 to 15 minutes and you will be taken back to the ward afterwards to rest. Sometimes we are unable to place the PEG tube, if this is the case you should be able to go home the same day and have an option of a “rescue feeding via a nasal gastric tube“ if needed.
Your throat may be slightly sore for a few days and where the tube is inserted in your abdomen may be sore for up to a week. Simple pain relief such as paracetamol is usually helpful. You will need to stay in hospital overnight after your PEG insertion so that staff can observe for any problems. Most people are discharged the following day.
Your PEG is held in place with a balloon filled with water, this requires checking every week. The District Nurse can help with this, they will also remove stitches after 14 days. After 14 days the tube clip needs to be released and the tube pushed in and rotated to prevent it catching underneath the stomach lining. This needs to be done daily. The PEG tube will need to be replaced for a different balloon Gastrostomy tube, 12 weeks after initial placement.
You will be shown how to look after your PEG tube before you leave the hospital after it is put in. You will also be given a booklet called ‘Balloon Gastrostomy Feeding: Care Guidelines for patients and carers’. It is important to follow all of the care instructions in this booklet.
After your discharge you will be contacted by the nurse who will train you how to administer feeds through your tube. You will be given a small supply of syringes on discharge so you can practice with them after your training.
When your Consultant is happy that you are eating enough, without the need of the PEG, after completion of your treatment, the tube can be removed and the PEG tube site will heal up naturally.
If you have problems with the PEG tube itself you may contact the Gastroenterology Unit at Blackpool Victoria Hospital using the details on the back of this leaflet.
Out of hours, if your PEG comes out, you will need to attend Accident and Emergency.
