PERCUTANEOUS ENDOSCOPIC GASTROSTOMY
(PEG Tube Insertion)
What is PEG (Percutaneous Endoscopic Gastrostomy) Placement?
- A PEG placement is an insertion of a feeding tube through the abdominal wall into the stomach during an upper endoscopy. A small incision is made on the abdomen, and then a small, flexible tube (catheter) with a balloon or flared tip is inserted through the stomach.
Indication for PEG Tube Placement:
- It is recommended for patient who had birth defects of the mouth, esophagus, or stomach (esophageal or tracheal esophageal fistula).
- Patients who cannot swallow correctly e.q. after stroke.
- Patients who are unconscious or who have a reduced level of consciousness therefore are not able to eat.
- Patient with neurological conditions such as head injury, cerebral palsy, motor neuron disease.
- Malnourished patients who cannot take enough food by mouth to maintain their nutrition.
- Patients unable to tolerate a nasogastric tube or a certain reasons long-term nasogastric tube feeding is not appropriate.
Preparation for PEG Placement:
- No food or liquids minimally 6 to 8 hours prior to the procedure.
- The procedure is performed with intravenous sedation. You are routinely admitted for observation and antibiotics.
- Doctor should be inform of any special needs, medical condition, allergies, or current medication the patient is taking.
- For many patients, PEG placement can be quite a traumatic procedure. Therefore, it is important that patient and patient's family has been prepare adequately and explained all the complication there is in the procedure.
- For any question or problems following PEG placement, the doctor and the nurse are available for advice regarding home care, care routines, mouth care, and common problems.
How is PEG Placement performed:
- It is the procedure requires the services of two physicians. After administering a local anesthetic, one physician inserts a cannula into the stomach through an abdominal incision and then threads a non absorbable suture through the cannula, the second physician looks through an endoscope that has been passed into the upper G.I. tract and uses the endoscopic snare to grasp the end of the suture and guide it up through the patient's mouth the suture is knotted to the dilator tip at the end of the PEG tube. The endoscopist then advances the dilator tip through the patient's mouth while the first physician pulls the suture through the cannula site. The attached PEG tube is guided down to the esophagus, into the stomach and out through the abdominal incision. The catheter tip and the internal crossbar secure the tube against the stomach wall. An external crossbar or bumper keeps the catheter in place. A tubing adaptor is in place between feedings, and a clamp or plug is used to close or open the tubing. If an endoscope is unable to pass through the esophagus, the gastrostomy can be performed under x-ray guidance through the abdominal wall. The procedure is known as Fluoroscopically Guided Percutaneous Gastrostomy or FGPG.