Percutaneous Endoscopic Gastrostomy (PEG)

Percutaneous endoscopic gastrostomy (PEG) is a surgical procedure for placing a tube for feeding without having to perform an open operation on the abdomen (laparotomy). It is used in patients who cannot take in food orally for a prolonged period. A gastrostomy, or surgical opening into the stomach, is made through the skin using a flexible, lighted instrument (endoscope) passed orally into the stomach to assist with placing the tube and securing it in place.

The purpose of a percutaneous endoscopic gastrostomy is to feed those patients who cannot swallow food. Irrespective of the age of the patient or their medical condition, the purpose of percutaneous endoscopic gastrostomy is to provide fluids and nutrition directly into the stomach.

Percutaneous endoscopic gastrostomy is done by a physician. The physician may be a general surgeon, an otolaryngologist (ENT specialist), a radiologist, or a gastroenterologist (gastrointestinal specialist).

PEG is performed in a hospital or outpatient surgical facility. It is not necessary to perform a percutaneous endoscopic gastrostomy in an operating room.

Local anesthesia (usually lidocaine or another spray) is used to anesthetize the throat. An endoscope (a flexible tube with a camera and a light on the end) is passed through the mouth, throat and esophagus into the stomach. The physician then makes a small incision (cut) in the skin of the abdomen over the stomach and pushes a needle through the skin and into the stomach. The tube for feeding then is pushed through the needle and into the stomach. The tube then is sutured (tied) in place to the skin.

The patient usually can go home the same day or the next morning, unless they are in the hospital for other reasons.

Percutaneous endoscopic gastrostomy takes less time, carries less risk, and costs less than a surgical gastrostomy which requires opening the abdomen. Percutaneous endoscopic gastrostomy is commonly performed, so there are many physicians with experience in performing the procedure. When feasible, percutaneous endoscopic gastrostomy is preferable to a surgical gastrostomy.

Possible complications include infection of the puncture site (as in any kind of surgery,) dislodgement of the tube with leakage of the liquid diet that is fed through the tube into the abdomen and clogging of the tube.