Percutaneous Endoscopic Gastrostomy

Percutaneous endoscopic gastrostomy is abbreviated as PEG. It means an introduction of a feeding tube through the abdominal wall into the stomach. PEG is a special type of nutritional approach, which is chosen only when absolutely necessary.


The procedure begins with a classic upper GI endoscopy. The endoscopic device is inserted through mouth and esophagus into the stomach. The light source of the endoscope illuminates the inside of the stomach and it even visibly shines through the abdominal wall. This helps to locate the skin area just above the stomach. The procedure continues with creating a small opening in the abdominal wall, which is used for introduction of the PEG feeding tube. The tube is fixed to the stomach wall by a special bumper. In fact, the exact procedure is much more complex and it has more steps, but the above mentioned description is sufficient in my opinion.


PEG tube can be also inserted surgically. The surgeon cuts through the abdominal wall and inserts the feeding tube into the stomach. The wound is much larger than the endoscopic method and surgical PEG introduction only when the endoscopic approach is not possible.


The PEG serves for administration of special nutritive solutions. Initially, we administer only small doses, but their volumes may increase according to patient's tolerance. The ideal feeding is in form of smaller doses that are administered regularly more times a day with a six hour long break during the night. Every dose of nutrition is washed down with tea or another liquid. Theoretically, it is possible to use normal diet, which is mashed to fit into the tube.


PEG is useful in patients who are unable for some reason to take enough food by mouth. These situations include states with impaired consciousness, neurological disorders (prolonged coma, strokes, paralysis of the nerves controlling the swallowing, severe dementia) and then some serious swallowing disorders. Typical indications may be tumor of the throat including laryngeal cancer and esophageal cancer, obstructing the digestive tube. PEG does not have to be permanent solution. When the affected person gets well and the indication of PEG disappears, the PEG can be easily removed.


Note: PEG is not desirable as a part of care in dying patients in the last stages of their disease who are unable to ingest.


Side view of the established PEG - tube passes from the stomach
through the abdominal wall and opens out on the body surface



The main advantage is that PEG enables a relatively natural food intake. The food normally passes through the intestines, which supports intestinal mucosa and prevents it from atrophy. The patient could have intravenous nutrition, but it completely bypasses the gut and long-term inactivity disrupts the intestinal mucous membrane. In addition, the PEG care is very easy and the patient with PEG may be treated at home.


The abdominal wall around the tube may get affected by infection. This can be treated by antibiotics, but when the situation can not be solved conservatively, the PEG tube must be removed. When we put too large doses of nutrition into the PEG, we may overload the digestive tract, which manifests vomiting, diarrhea and nausea (if the patient is conscious).


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources