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Percutaneous Endoscopic Gastrostomy - Indications, Contraindications, and Procedure

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Percutaneous endoscopic gastrostomy is a medical procedure done to place a feeding tube in a patient. Read the article below to know more about it.

Medically reviewed by

Dr. Jagdish Singh

Published At September 2, 2022
Reviewed AtApril 24, 2023

Introduction:

Dysphagia, the difficulty in swallowing foods and liquids, occurs in people in the throat or esophagus. This can range from mild to moderate, and sometimes, it can block the passage of food completely. Sometimes individuals are unable to swallow food due to coughing, choking while eating or drinking, or bringing back food up occasionally through the nose. Individuals with certain systemic conditions also face dysphagia. Percutaneous endoscopic gastrostomy helps in all the above conditions to provide adequate nutrition to the required individual.

What Is Percutaneous Endoscopic Gastrostomy (PEG)?

Percutaneous endoscopic gastrostomy is a type of enteral feeding in cases of difficulty swallowing and conditions where the individual fails to receive nutrition through the mouth and needs enteral nutrition. In this state, surgery is performed to place a feeding tube. These feeding tubes (PEG tubes or G tubes) allow the absorption of nutrition from the stomach. This medical procedure is called percutaneous endoscopic gastrostomy.

Who Is Often in Need of Percutaneous Endoscopic Gastrostomy?

Individuals who are suffering from dysphagia (difficulty in swallowing) or conditions that lead to dysphagia need percutaneous endoscopic gastrostomy. Conditions like:

  • Stroke.

  • Head and neck injury.

  • Brain injury.

  • Chronic appetite loss due to severe illness like cancer.

  • Individuals also get benefits in conditions of cystic fibrosis or dialysis in kidney failure.

  • Individuals in the condition of coma may receive percutaneous endoscopic gastrostomy to receive nutrition and be alive.

What Is Done Prior to Percutaneous Endoscopic Gastrostomy?

Before the procedure starts, your health care provider will consult with you regarding your medical conditions related to the heart, medical allergies, or bleeding disorders. Depending on your medical history and underlying conditions, some medical adjustment is required. The changes and restrictions are made like insulin dosage, NSAIDs (nonsteroidal anti-inflammatory drugs) like Aspirin, and blood thinners like Warfarin. Avoid eating or drinking at least eight hours before the procedure.

What Is the Procedure Done for Percutaneous Endoscopic Gastrostomy?

Percutaneous endoscopic procedures are placed using a small incision. A long flexible instrument, an endoscope, is used. Before the procedure, IV (intravenous) anesthesia and antibiotics (to prevent infection) are administered, which will make the individual numb during the procedure. Along with it, you may also receive local anesthesia.

After that, a small incision is made in the upper abdomen. Placing the tube through the incision is done, connecting the tube to the stomach. Occasionally contrast is injected via the PEG to determine the position, called a PEGogram. This entire procedure takes around 30 to 20 minutes. Usually, the patient can return home the same day or the next morning.

What Happens After the Procedure of Percutaneous Endoscopic Gastrostomy?

Pain persists after percutaneous endoscopic gastrostomy. This pain may be a result of the incision made for the tube placement or cramps due to the gas build-up in the digestive tract. This pain may subside within 24 to 48 hours. Some drainage around the site of incision is noticed till 48 hours. A bandage is placed over the site of the incision. The health care provider will instruct you regarding the removal of the bandage, which may probably be within two days.

You will have a session with the dietician, who will guide you on using the PEG tube and how to get started on internal nutrition.

How Long Does Percutaneous Endoscopic Gastrostomy Last?

Percutaneous endoscopic gastrostomy lasts for months or years. In cases of any breakdown or clogging over extended periods of time, the tubes need to be replaced, and health care providers may remove and replace the tube without sedation, but in rare cases, sedation is required. The provider may remove the tube using firm traction and insert a new tube. In cases of new tube replacement, the opening closes on its own. The percutaneous endoscopic gastrostomy site closes quickly on its own, so immediate attention is required in cases of accidental dislodgement.

What Are the Indications of Percutaneous Endoscopic Gastrostomy?

  • Percutaneous endoscopic gastrostomy is indicated in conditions in which normal nasogastric feeding is not possible. Conditions like stroke, cleft lip, palate, and tumors of the head and neck.

  • In advanced dementia (a condition affecting memory thinking capacity that severely interferes with daily life activities), percutaneous endoscopic gastrostomy does not result in prolonged life. Instead, oral assisted feeding is preferred. In patients with malignant bowel obstruction, venting PEG is used and is placed to prevent nausea and vomiting.

  • Gastrostomy can be used to treat the volvulus of the stomach when the stomach twists along one of its axes.

What Are the Contraindications of Percutaneous Endoscopic Gastrostomy?

Care must be taken while the placement of the PEG tubes. The contraindications of the usage of percutaneous endoscopic gastrostomy are:

Absolute Contraindications:

  • Peritonitis (inflammation of the peritoneum- inner abdominal wall).

  • Uncorrected coagulopathy.

  • Untreatable massive ascites.

  • Inability to perform an esophagogastroduodenoscopy.

  • Bowel obstruction.

Relative Contraindications:

  • Gastric wall neoplasm.

  • Massive ascites.

  • Infection of the abdominal wall.

  • Gastric mucosal abnormalities, large gastric varices.

  • Portal hypertensive gastropathy.

  • Previous abdominal surgery along with partial gastrectomy.

  • Morbid obesity.

  • Intra-abdominal malignancy with peritoneal involvement.

What Are the Complications of Percutaneous Endoscopic Gastrostomy?

The complications of percutaneous endoscopic gastrostomy are:

  • Hemorrhage.

  • A gastric ulcer on the site or on the opposite wall of the stomach is also known as a kissing ulcer.

  • Perforation of the bowel leads to peritonitis.

  • Infection at the site of surgery around the gastrostomy site. Intravenous antibiotics can reduce infection around the gastrostomy site.

  • A puncture on the left lobe of the liver leads to liver capsule pain.

  • Gastric separation.

  • The gastric part of the tube migrates into the gastric wall- buried bumper syndrome (caused due to overgrowth of gastric mucosa over the inner bumper of gastrostomy tubes).

  • Gastrocolic fistula (rare presentation of malignant and benign gastric conditions).

How to Take Care of Percutaneous Endoscopic Gastrostomy Site?

Drainage sound at the site of the PEG tube is common in the initial one or two days. The area around heals in two to three weeks.

  • You need to clean the skin around the tube one to three times a day. Use mild soap or saline water along with a cotton swab or gauze.

  • Gently remove any drainage or crusting over the skin and tubes. Do not pull the tube on your own and prevent it from being pulled.

  • Dry the skin with a clean towel or gauze. Avoid bulky dressings, and do not put the gauze under the disc.

  • Do not use any kind of ointments, sprays, or powders around the tubes. Consult your provider and ask whether it is okay to shower or to take a bath.

When to Contact Your Health Care Provider in Cases of Percutaneous Endoscopic Gastrostomy?

You should contact your health care provider if you have the following issues:

  • Redness or irritation on the skin surface around the tube.

  • Leakage around the tube or system.

  • If the PEG tube is blocked.

  • Any signs of bleeding from the tube insertion site.

  • Diarrhea after feedings.

  • Worsening pain.

  • Hard and swollen belly even after one hour after feeding.

  • Feeling constipated, passing hard and dry stools.

  • Coughing more than usual or feeling of shortness of breath.

Conclusion:

Percutaneous endoscopic gastrostomy permits fluids, nutrition, and medications directly into the stomach by passing through the mouth and esophagus, which is typically performed on patients who are unable to eat or drink directly or consume nutrition orally. It is necessary to imagine complications associated with percutaneous endoscopic gastrostomy soon after insertion or later. Most of the time, complications are associated with displacement, including buried bumper syndrome.

Frequently Asked Questions

1.

Is Percutaneous Endoscopic Gastrostomy a Permanent Procedure?

Percutaneous endoscopic gastrostomy is done in case of severe dysphagia or difficulty swallowing water and food. The tube is inserted for a shorter duration if a person starts eating and drinking on their own. However, in severe conditions, long-term use of the percutaneous endoscopic gastrostomy (PEG) tube is advised by the doctor if a patient cannot eat or drink due to blockage.

2.

Is Percutaneous Endoscopic Gastrostomy Placement Considered a Major Surgery?

Percutaneous endoscopic gastrostomy (PEG) is a simple surgical procedure that does not require significant intervention in the abdominal cavity. Instead, the doctor makes a small incision on the upper abdomen with the help of an endoscopic instrument. A person is given antibiotics and intravenous anesthesia to numb the area during the procedure.

3.

How Much Time Does Percutaneous Endoscopic Gastrostomy Tube Take To Heal?

Percutaneous endoscopic gastrostomy causes pain at the incision site after the procedure is completed. Pain persists due to continuous gas build-up in the abdomen and the cramps due to tube insertion. On average, the pain may last up to 24 to 48 hours, with some drainage around the incision.

4.

How Long Can a Person Survive With a Percutaneous Endoscopic Gastrostomy Tube?

A person with a percutaneous endoscopic gastrostomy (PEG) tube can live up to 30 days to one year, depending on the patient’s condition. However, severe dysphagia can lead to health complications and other tube insertion risks. In addition, the nutritional supply of the body is hampered, and thus the mortality risk also increases with prolonged use of PEG tubes.

5.

Can a Person Remove Percutaneous Endoscopic Gastrostomy Tube at Home?

A person cannot remove a percutaneous endoscopic gastrostomy tube at home. The tube is placed inside the stomach by an expert by making an incision and stabilizing the tube in one place. The healthcare provider only guides the person about cleaning the skin around the incision area to avoid infection. The PEG tube is removed by the professional only.

6.

When Should a Percutaneous Endoscopic Gastrostomy Tube Be Removed?

A percutaneous endoscopic gastrostomy tube is usually removed only if clogging or breakdown occurs over a while. The doctor replaces the tube without any anesthesia or sedation, but in some rare cases, a person may need sedation. The tube only needs replacement in rare conditions but usually lasts for a few months to years.

7.

How Painful Is a PEG Tube?

Percutaneous endoscopic gastrostomy (PEG) tube placement is painful initially due to incision. A person may feel abdominal discomfort due to swelling caused by the incision made during the procedure. However, the pain usually goes away within seven to ten days.

8.

What Is the Most Common Complication Associated With Tube Feeding?

Percutaneous endoscopic gastrostomy (PEG) tube can cause inflammation of the inner abdominal wall (peritonitis), puncture of the left lobe of the liver, bleeding, benign or malignant gastric problems, and gastric ulcers on the incision site. In addition, PEG also leads to gastric separation and buried-bumper syndrome (tubes get buried into the gastric wall). It can also cause infection at the site of the gastrostomy site.

9.

What Is the Alternative to Feeding Tubes?

The doctor can treat difficulty swallowing or obstruction in the digestive system with many options. An alternative to percutaneous endoscopic gastrostomy includes a nasojejunal feeding tube (NJ) and a nasogastric feeding tube (NG). All these feeding tubes are used to feed the person depending on their condition and to supply nutrition as per their needs.

10.

What Happens if a Person’s Body Rejects a PEG Tube?

When a person cannot eat or drink due to severe obstruction in the digestive tract, feeding tubes are inserted by the doctor. In case the body of a person does not respond to feeding tubes, the nutrition cannot be supplied to the patient. Therefore, this condition can slow down the person’s body, and their survival chances also decrease due to lack of nutrition.

11.

Is There a Ballon Attached to the PEG Tube?

Some of the PEG tubes have a balloon at the end to keep them stable and avoid the dislodgement of the tube. The balloon is blown up after being inserted in the stomach, and the end of the tube gets inflated, which holds the tube in place. However, this balloon is not present in all PEG or G-tubes.

12.

Is There a Similarity Between a G-Tube and PEG Tube?

A percutaneous endoscopic gastrostomy tube is often called a PEG tube or G-tube. They are used for feeding an individual directly through the abdomen if they have dysphagia or severe obstruction in swallowing food and water. G-tube stands for the gastrostomy tube, and the PEG tube is called a percutaneous endoscopic gastrostomy tube.

13.

How Frequently Should a Person Change the Gastrostomy Button?

The gastrostomy button is held in its place by a water-filled balloon on either side. The button needs to be replaced for various reasons, such as leakage in the balloon. However, it is recommended to change the button every three to four months, and the water inside the balloon should be replaced every week with the help of a syringe.
Dr. Jagdish Singh
Dr. Jagdish Singh

Medical Gastroenterology

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