What is Percutaneous Endoscopic Gastrostomy (PEG)?
Percutaneous endoscopic gastrostomy (PEG) is a medical procedure involving the placement of a feeding tube directly into the stomach through the abdominal wall. It is a type of enteral nutrition, meaning it uses the gastrointestinal tract for digestion. This method is often chosen when a person has a functioning digestive system but is unable to take in enough food and fluids by mouth due to a variety of medical conditions. The name of the procedure can be broken down to understand its components:
- Percutaneous: Means "through the skin," indicating the entry point.
- Endoscopic: Refers to the use of an endoscope, a thin, flexible tube with a camera, to guide the placement of the feeding tube.
- Gastrostomy: Means "making an opening into the stomach".
The resulting tube, often called a PEG tube or G-tube, has a small plastic disc or bumper inside the stomach to secure it, and another on the outside against the skin.
Why is PEG Feeding Needed?
PEG feeding is indicated for patients who require long-term nutritional support, typically for more than four to six weeks. The reasons a person may need a PEG tube are varied and often relate to the inability to swallow or consume sufficient nutrition orally.
Indications for PEG tube placement
- Swallowing difficulties (dysphagia): This can result from conditions like stroke, head and neck cancers, or neurological disorders.
- Neurological disorders: Diseases such as motor neuron disease (ALS), multiple sclerosis, and Parkinson's disease can impair the ability to swallow effectively.
- Chronic illness: Conditions like cystic fibrosis, HIV/AIDS, or severe burns can lead to chronic poor appetite and malnutrition.
- Coma: For patients with a reduced level of consciousness who require long-term feeding.
- Gastric decompression: In some cases of gastric volvulus or bowel obstruction, a PEG tube can be used to drain stomach secretions and relieve pressure.
The PEG Placement Procedure
The placement of a PEG tube is a relatively minor and common procedure that usually takes about 20 to 30 minutes. It is performed under sedation and local anesthesia, rather than general anesthesia, making it safer for many patients.
A step-by-step overview
- Preparation: The patient is asked to fast for several hours before the procedure to ensure the stomach is empty. An intravenous (IV) line is placed to administer sedation and an antibiotic to prevent infection.
- Endoscopic guidance: An endoscope is passed through the mouth, down the esophagus, and into the stomach. The stomach is then inflated with air for better visualization.
- Site selection: Using the endoscope's light to transilluminate the abdominal wall, the doctor identifies the ideal spot for the tube insertion.
- Incision and placement: A small incision is made in the abdominal skin. A wire is passed through the incision into the stomach and pulled out through the patient's mouth. The feeding tube is then attached to this wire and pulled back through the esophagus, stomach, and out of the abdominal wall.
- Securing the tube: Once in place, the internal bumper and an external bumper are used to secure the tube and prevent it from dislodging.
Comparing PEG to Other Feeding Methods
PEG feeding is often chosen for long-term nutritional needs due to its greater comfort and ease of management compared to other options like a nasogastric (NG) tube.
| Feature | PEG Tube | Nasogastric (NG) Tube |
|---|---|---|
| Duration of use | Long-term (more than 4-6 weeks). | Short-term (less than 4-6 weeks). |
| Insertion method | Percutaneous, via an incision in the abdominal wall under endoscopic guidance. | Nasal, via the nostril and down into the stomach. |
| Patient comfort | Generally more comfortable for long-term use as it is less intrusive. | Can be irritating to the nose, throat, and esophagus. |
| Visibility | Easily concealed under clothing, improving privacy. | Visible on the face, which can affect a person's self-image. |
| Risk of aspiration | Reduced risk compared to NG tubes, especially in patients with swallowing disorders. | Higher risk of aspiration, as the tube can interfere with the function of the esophageal sphincter. |
| Tube care | Daily cleaning of the stoma site is required to prevent infection. | Regular replacement is necessary, and it can be prone to clogging. |
Living with a PEG Tube: Care and Management
Proper care is crucial for preventing complications and ensuring the longevity of a PEG tube. Patients and caregivers are trained on how to manage the tube at home, often with support from community nutrition nurses.
Daily care routine
- Hand hygiene: Always wash hands with soap and water before handling the tube or stoma site.
- Site cleaning: The skin around the tube's insertion point (the stoma) should be cleaned daily with mild soap and water and kept dry.
- Flushing: The tube must be flushed with water before and after each feeding or medication administration to prevent blockages.
- Rotating: The tube should be gently rotated 360 degrees daily to prevent the internal bumper from becoming embedded in the stomach wall.
Potential complications
While considered safe, complications can occur:
- Infection: The most common risk, which can be minimized with good hygiene.
- Tube dislodgement or blockage: The tube can accidentally come out or become clogged, requiring immediate medical attention.
- Leakage: Stomach contents can leak around the insertion site, causing skin irritation.
- Aspiration pneumonia: Although less common than with NG tubes, aspiration can still occur.
- Bleeding or perforation: Rare but serious complications that can occur during insertion.
Benefits of PEG Feeding
For the right patient, PEG feeding offers significant benefits, improving health and quality of life. These include:
- Improved nutritional status: Ensures the patient receives adequate calories, protein, and fluids, which can prevent malnutrition and weight loss.
- Enhanced comfort and convenience: PEG tubes are less intrusive than NG tubes and can be easily hidden, leading to greater patient comfort and improved body image.
- Reduced risk of aspiration: For individuals with impaired swallowing, a PEG tube significantly lowers the risk of food or liquid entering the lungs.
- Facilitates recovery and discharge: For patients with a temporary need for nutritional support, a PEG tube can aid recovery and enable earlier discharge from the hospital.
- Allows for specific nutritional formulas: Patients can receive specialized liquid diets tailored to their individual medical needs.
For more detailed information on enteral feeding and nutritional support guidelines, resources from the National Institutes of Health can be a valuable starting point, such as this guide on percutaneous endoscopic gastrostomy.
Conclusion
PEG feeding is a cornerstone of modern nutritional support, providing a safe and effective way to deliver essential nutrients to patients who cannot eat orally. It involves the endoscopic placement of a feeding tube directly into the stomach, offering a long-term solution that is generally well-tolerated and can significantly improve patient health and comfort. While requiring dedicated care and management, the procedure allows individuals with conditions like stroke, neurological disorders, or head and neck cancer to maintain their nutritional status and quality of life. The decision to opt for a PEG tube is made in consultation with a healthcare team, considering the patient's overall health and long-term prognosis.
