Percutaneous endoscopic gastrostomy (peg)

Percutaneous endoscopic gastrostomy (PEG) is a procedure to make an opening between the skin of your belly and your stomach. The doctor will put a thin tube called a gastrostomy tube into your stomach through the opening. This tube is sometimes called a G-tube, a PEG tube, or a feeding tube. The tube can put liquid nutrition, fluid, and medicines directly into your stomach. It also may be used to drain liquid or air from the stomach.

The doctor will put a thin, lighted tube (scope) into your mouth. The scope is used to guide the feeding tube to the stomach. The doctor will pull the end of the feeding tube through an incision in your belly. This end of the tube stays outside the body.

You will probably be able to go home on the day of the procedure or the day after. Before you go home, your doctor or nurse will teach you how to use and care for your feeding tube.

You will get medicine to numb the back of your throat. You also will get medicine to make you sleep or feel relaxed. The medicine also prevents pain during the procedure. The doctor will put a thin, lighted tube that bends (called an endoscope, or scope) into your mouth. The doctor will move the scope gently down your throat. The scope will have a camera on it. The doctor will look at a monitor (like a TV set or a computer screen) while moving the scope into your stomach. Puffs of air will be sent through the scope. This inflates your stomach. It helps the doctor see where to place the feeding tube.

The doctor will make a small cut in your belly. The cut is called an incision. The doctor will put the feeding tube into your mouth. The tube will be guided down your throat into your stomach. The doctor will pull one end of the feeding tube out of your belly through the incision. This end of the feeding tube will stay outside your body. The other end will stay in your stomach. The doctor may use stitches to close the incision around the feeding tube.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Ask your doctor when you can drive again.
• Until your doctor says it is okay, avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, a vacuum cleaner, or a child.
• You can shower as usual. Pat dry the skin around your feeding tube. Do not take a bath unless your doctor tells you it is okay.

Diet

• Follow your doctor's instructions about eating and drinking.
• Follow your doctor's instructions about what nutrition and fluids to feed through your tube.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also be given instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• If you take medicine through your feeding tube:
  • Follow exactly your doctor's instructions about how to do this. Do not try to put whole pills in your feeding tube. They may get stuck. Ask your doctor if liquid medicine is available.
  • Do not mix your medicine with tube-feeding formula. This can cause a clog in the feeding tube.
  • Do not put more than one medicine down your feeding tube at a time.
  • Flush the tube with water before and after you put each medicine down your tube.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • Store your prescription pain medicines where no one else can get to them. When you are done using them, dispose of them quickly and safely. Your local pharmacy or hospital may have a drop-off site.

Incision care

• Your doctor or nurse will show you how to care for the skin around the tube. Be sure to follow the instructions on keeping the area clean.
• Wash the skin around your feeding tube daily with warm, soapy water, and pat it dry. Other cleaning products, such as hydrogen peroxide, can make the wound heal more slowly. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

Using your feeding tube

• Follow your doctor's instructions about using the feeding tube. Your doctor or nurse will:
  • Tell you what to put through the tube.
  • Teach you how to watch for a leaking tube, infection at the tube site, or a clog in the tube.
  • Tell you what activities you can do.
• Keep your feeding tube clamped unless you are using it.
• Keep the tube taped to your skin at all times, and leave some slack in the tube. This helps prevent pain and keeps the tube from coming out.
• Wash your hands before you handle the tube and tube-feeding formula. Wash the top of the can of formula before you open it.
• Keep the formula in the refrigerator after you open it. Follow your doctor's instructions about how long formula can sit out at room temperature.
• Sit up or keep your head up during the feeding and for 30 to 60 minutes after.
• If you feel sick to your stomach or have stomach cramps during the tube feeding, slow the rate that the formula comes through the tube. Then gradually increase the rate as you can tolerate it.