Percutaneous Endoscopic Gastrostomy (PEG)

Percutaneous Endoscopic Gastrostomy (PEG)

Percutaneous Endoscopic Gastrostomy (PEG) is a minimally invasive procedure that allows direct feeding into the stomach through the abdominal wall using a tube, intended for patients who cannot eat orally or suffer from malnutrition. Compared to surgical gastrostomy, PEG offers advantages such as lower risk, reduced invasiveness, and faster recovery time.

Who Is PEG Performed For? (Indications)

PEG is applied to patients for whom oral feeding is impossible or dangerous due to aspiration risk. These conditions include:

• Neurological Disorders: Conditions like stroke, Parkinson’s disease, Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), and cerebral palsy can cause dysphagia and impair oral feeding.
• Head and Neck Cancers: PEG can be used for temporary or permanent nutritional support in patients who develop dysphagia after surgery or radiotherapy.
• Traumatic Brain Injury: Patients with impaired consciousness who cannot feed orally may benefit from PEG.
• Critically Ill and ICU Patients: PEG is preferred to prevent complications from prolonged use of nasogastric tubes in patients requiring long-term intubation and mechanical ventilation.
• Gastrointestinal Problems: Conditions such as strictures in the esophagus, esophageal tumors, or pyloric stenosis can make oral feeding impossible.

Who Performs the PEG Procedure?

PEG is usually performed by gastroenterologists or general surgeons experienced in endoscopy. An anesthesiologist or sedation nurse monitors the patient’s respiratory and circulatory functions during the procedure.

The typical PEG team includes:

• Gastroenterologist or General Surgeon: Performs the endoscopy and places the PEG tube.
• Anesthesiologist or Sedation Nurse: Administers sedation and monitors the patient’s comfort and vital signs.
• Endoscopy Nurse: Prepares instruments, assists positioning, and supports post-procedure care.

How Is PEG Performed? (Procedure Steps)

PEG is a short procedure lasting about 15–30 minutes, performed under local anesthesia and endoscopic guidance. The main steps are:

Patient Preparation

• Fasting for at least 6–8 hours prior to the procedure is required.
• For patients on anticoagulants, medications are adjusted to reduce bleeding risk.
• Mild sedation is typically administered; general anesthesia is usually not necessary.

Endoscopic Visualization

• A flexible endoscope is passed through the mouth into the stomach to assess the inner surface.
• The optimal site for insertion on the abdominal wall (usually the anterior wall of the stomach) is determined.

Creating the Gastrostomy

• A small incision is made in the abdominal wall after local anesthesia is applied.
• A special needle is used to puncture into the stomach, and a guidewire is passed with endoscopic assistance.

Placing the PEG Tube

• The PEG tube is guided into the stomach using the wire and pulled through the abdominal wall.
• An internal stopper holds the tube in place inside the stomach, and the external part is secured to the skin.

Post-Procedure Control

• The tube’s position is tested for accuracy and leakage.
• For the first 24 hours, the site is monitored for leakage of gastric contents.

Post-PEG Care and Potential Complications

Care and Usage:

• Only intravenous fluids are given for the first 24 hours; then, liquids and pureed foods are gradually introduced through the PEG tube.
• The insertion site should be cleaned regularly and monitored for signs of infection.
• After each feeding, the tube should be flushed with warm water to prevent clogging.

Potential Complications:

• Local Infection: Redness, discharge, or swelling around the insertion site.
• Bleeding: Rarely, injury to blood vessels in the stomach or abdominal wall may occur.
• Peritonitis: Leakage of stomach contents into the abdominal cavity, potentially causing infection.
• Tube Blockage: Accumulation of food residue in improperly cleaned tubes.

Advantages and Importance of PEG

• Minimally invasive: PEG poses less risk and offers faster recovery compared to surgical gastrostomy.
• Improved patient comfort: Suitable for long-term use, unlike nasogastric tubes.
• Safe nutrition: Reduces the risk of aspiration pneumonia in patients with swallowing difficulties.
• Home care friendly: Enables patients to receive long-term nutritional support at home.

Conclusion

Percutaneous Endoscopic Gastrostomy (PEG) is a safe and effective long-term feeding method for patients who cannot eat orally. It is reversible and does not prevent future oral intake. Performed by gastroenterologists or general surgeons under endoscopic guidance, PEG offers vital nutritional support for patients with dysphagia or chronic feeding disorders. With proper care and patient management, PEG enhances overall health outcomes while minimizing complication risks.