Percutaneous Endoscopic Gastrostomy (PEG)
What is a percutaneous endoscopic gastrostomy (PEG)?
A PEG is a feeding tube that is inserted directly into the stomach through the abdominal wall. It allows nutrition, hydration, and medications to be given directly into the stomach in people who are unable to eat or drink safely by mouth. The procedure is performed using an endoscope (a thin, flexible camera passed into the stomach via the mouth) whilst the patient is under anaesthetic/sedation.
What is a PEG-J?
A PEG-J is a variation of the PEG tube that extends further into the small bowel (jejunum). It is used when feeding into the stomach is not appropriate—for example, due to poor gastric emptying, reflux, or frequent aspiration events with feeding into the stomach. The PEG tube is inserted in the usual way, and a thinner tube is then threaded through it and into the small intestine.
When is a PEG tube needed?
PEG tubes are used for people who require long-term nutritional support and are unable to maintain adequate nutrition orally. Common reasons include:
Neurological conditions affecting swallowing
Head and neck cancers or treatments causing difficulty swallowing
Severe or persistent swallowing difficulties from other causes
What is the preparation?
Preparation for PEG insertion is similar to that for a gastroscopy:
You will need to fast for at least 6 hours before the procedure. You may take small sips of water up to 2 hours before
Please inform Dr Clark-Dickson if you are taking any blood-thinning medications (e.g. aspirin, clopidogrel, ticagrelor, warfarin, apixaban, rivaroxaban, or dabigatran), as these will need to be adjusted beforehand
How is it performed?
PEG insertion is usually performed under sedation or general anaesthesia. You will also be given antibiotics to reduce the risk of infection.
An endoscope is passed through your mouth into your stomach to locate the ideal position for the PEG tube.
The skin a the appropriate location on the upper abdomen is cleaned and numbed with local anaesthetic, and a small cut is made.
A cannula is passed through the skin and into the stomach. A wire is threaded through this cannula and grasped using the endoscope.
The wire is pulled back out through your mouth and used to pull the PEG tube down through your mouth, into your stomach, and out through the abdominal wall.
The internal end of the tube sits securely in your stomach, and the external end rests against the skin.
The entire procedure usually takes around 30 minutes.
What are the risks?
PEG insertion is generally safe, but like all procedures, it carries some risks:
Common or minor risks:
Infection around the insertion site
Minor bleeding
Leakage around the tube (peristomal leakage)
Uncommon or serious risks (~3% of cases):
Peritonitis (infection in the abdominal cavity)
Aspiration pneumonia (inhalation of stomach contents into the lungs)
Major bleeding
Inadvertent perforation or formation of abnormal connections between organs (fistulae)
What happens after the procedure?
After the procedure:
You will be monitored in recovery until the sedation has worn off
Once awake, I will discuss the findings with you and provide a written report
You will be kept nil by mouth and nil via PEG for 2–4 hours
Water flushes via the tube usually begin after 4 hours
If there are no complications, the PEG can be used for feeding and medications after 8 hours
The PEG tube generally needs to be replaced every 12 months. Tube exchanges are usually straightforward and do not require sedation or anaesthesia.
If the tube falls out or is accidentally removed, you must attend hospital as soon as possible, as the tract can close quickly, making reinsertion more difficult and increasing the risk of complications.
Can the PEG tube be removed?
Yes. The PEG tube can be removed when it is no longer needed. The tract usually closes on its own over time. In rare cases, the tract may remain open and require a further procedure to close it.