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For people considering having a PEG fitted, information taken from a post by Jeannie

Definition

A surgical procedure to place a tube inside of the stomach. This procedure is a less invasive alternative to an open abdominal operation (laparotomy).

Parts of the Body Involved
Stomach, skin, parts of the abdominal wall

Reasons for Procedure
A gastrostomy tube is used to:

Feed a person who has difficulty sucking or swallowing for up to 14 days or longer
Drain the stomach of accumulated acid and fluids in a person with a blockage between the stomach and the small intestine


Risk Factors for Complications During the Procedure
Stress
Obesity
Smoking
Excess consumption of alcohol
Use of narcotics or other mind-altering drugs
Use of certain prescription medications, including muscle relaxants and sedatives, anti-hypertensives, insulin, beta-adrenergic blockers, cortisone
Prior surgeries that involved or may have made positioning the abdomen difficult (such as a gastrectomy)
What to Expect
Prior to Procedure

Your doctor will likely do the following:

Physical exam
Medical history
Review of medications
Blood test
Urine test
X-rays of gastrointestinal tract
Endoscopic examination of stomach - an endoscope is a fiberoptic tube attached to a viewing device


In the days leading up to your procedure:

Do not take aspirin, aspirin-containing products, or anti-inflammatory drugs for one week before the procedure after discussing this with your
Do not eat or drink for at least eight hours before the procedure
Arrange for a ride to and from the procedure


Just before the procedure:

You'll remove eyeglasses and dentures
You'll remove your clothes and put on a hospital gown


During Procedure:

IV medications
Sedative
Anesthesia
An endoscope will be inserted into your stomach through your mouth


Anesthesia - Local, usually a lidocaine spray; IV pain reliever and a sedative

Description of the Procedure - This procedure is usually done by a surgeon and a gastroenterologist working together. An endoscope (a long, thin fiberoptic tube with a tiny video camera on its end) is inserted through the mouth and down the esophagus into the stomach. The endoscopic camera is used to produce pictures of the inside of the stomach on a video monitor so that the proper spot for insertion of the PEG feeding tube can be located.

The surgeon inserts a needle into the stomach at the spot where the PEG tube will be located. Using the endoscope, the gastroenterologist locates the end of the needle inside the body, and encircles it with a wire snare. A thin wire is then passed from the outside of the body, through this needle and into the abdomen. This wire is then grasped with the snare and pulled out through the mouth. Now, there is a thin wire entering the front of the abdomen into the stomach and continuing upward and out the mouth. The PEG feeding tube is attached to this wire outside of the mouth. The surgeon then pulls the wire back out from the abdomen, which pulls the PEG down into the body through the mouth and esophagus. The tube is pulled until the tip of the PEG comes out of the incision in the stomach. There is a soft, round "bumper" attached to the portion of the PEG that remains inside the body, this bumper secures the tube on the inside of the body. The outer portion of the tube is secured with a bumper as well. Sterile gauze is placed around the incision site.



Percutaneous Endoscopic Gastrostomy Procedure




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After Procedure - The PEG tube is secured to your abdomen with tape

How Long Will It Take?

30-45 minutes

Will It Hurt?

Anesthesia prevents pain during the procedure, although you may feel some discomfort. For a couple of days after the procedure, you may have minor pain and soreness at the incision site, which often feels like a pulled muscle. Your doctor can prescribe pain medications to relieve this discomfort.

Possible Complications:

PEG complications are relatively rare. Complications include:

Wound infection
PEG tube dislodgment or malfunction
Aspiration - accidental sucking into the airways of fluid, food, or any foreign material
Bowel perforation - a hole in the wall of the intestine
Gastrocolic fistula - an abnormal opening connecting the stomach and the colon
Peritonitis - inflammation of the lining of the abdomen
Septicemia - an infection affecting the entire body, caused by the spread of microorganisms and their toxins through the circulating blood
Leakage at the tube insertion site
Abdominal bloating
Nausea
Diarrhea
Irritation or infection of skin around the tube


Average Hospital Stay: 0-1 day

Postoperative Care:

When resting in bed, keep legs elevated and moving to avoid deep vein blood clots
Change the sterile gauze pads around the incision site regularly
Learn to feed yourself properly through the PEG feeding tube:
You'll receive fluids through an IV for a day or two, then you'll be advanced to clear liquids through the gastrostomy tube, and then to a formula
A dietitian will teach you how to use your PEG tube and how to choose an appropriate tube-feeding formula
Remain upright for 30-60 minutes after eating
Do not smoke
Learn the proper care of your PEG tube
Wash PEG tube and skin around tube regularly to avoid infection
Learn how to empty the stomach through the tube
Learn how to recognize and handle such problems as a blocked tube or a tube that falls out of place
Tape tube site when not in use to help prevent dislodging
Do not take prescription pain medication for more than seven days. After this point, take non-prescription pain relievers (such as ibuprofen) as necessary, but avoid taking aspirin or aspirin-containing products
To promote healing, resume normal activities as quickly as possible


Outcome
This procedure results in the placement of a workable alternative feeding site.

Call Your Doctor If Any of the Following Occurs
Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
Headaches, muscle aches, dizziness, fever, or general ill feeling
Nausea, constipation, or abdominal swelling
Vomiting
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