A minor surgical procedure in which a feeding tube is placed endoscopically directly into the stomach through the skin of the abdomen in patients with swallowing difficulty or who cannot be fed by mouth.
Indication
- Permanent swallowing disorder (dysphagia) after stroke
- Loss of safe swallowing in neurological diseases such as dementia, ALS or Parkinson's disease
- Inability to feed by mouth due to head and neck cancer or esophageal obstruction
- Patients on long-term mechanical ventilation
- Prolonged need for nutrition after head trauma or brain surgery
- All conditions requiring enteral nutrition for more than 4 weeks
Preparation
- No food or drink for 8 hours before the procedure
- Coagulation tests (INR, platelets) and blood group are performed
- Blood thinners are temporarily stopped with the doctor's approval
- A single dose of prophylactic antibiotic is given before the procedure
- Intravenous access is obtained; dental care/aspiration is performed when needed
How it's performed
- Under sedation, the patient is placed supine and vital signs are monitored
- An endoscope is advanced through the mouth into the stomach; the stomach is inflated with air
- The abdominal skin is sterilized, local anesthesia is applied and a suitable site is identified
- A guidewire is passed through a small puncture in the abdominal wall into the stomach
- The feeding tube is pulled with the help of the endoscope from the stomach to the skin and secured
- The position of the tube is checked and it is fixed to the skin with an external bumper
Post-procedure
- Feeding through the tube can be started 4-6 hours after the procedure
- On the first day the entry site is cleaned daily with an antiseptic and kept dry and covered
- Feeding is started slowly and increased gradually; the head is raised 30 degrees to prevent aspiration
- The tube is flushed with plenty of water before and after each use
- With proper care, a PEG tube is used for 6-12 months and replaced when needed
Risks
- Infection at the entry site (the most common complication, 5-10%)
- Subcutaneous bleeding or hematoma
- Tube dislodgement or blockage
- Aspiration pneumonia (rare; reduced with attention to feeding technique)
- Gastrointestinal perforation, peritonitis (very rare; 0.5-1%)
FAQ
Is a PEG permanent?
No. If the patient becomes able to feed by mouth again, the tube can be removed endoscopically or by simple traction; the skin opening usually closes on its own within a few days.
What can be given through the tube?
Ready-made enteral nutrition formulas recommended by the doctor, diluted home-cooked meals and suitable medications can be given. To prevent blockage, flush with 30-50 mL of water after each use.
Can the patient bathe?
The entry site should not be wet for the first 7-10 days. Once it has healed, showering is allowed; prolonged immersion of the procedure site in a bathtub or pool is not recommended.
What should I do if the tube comes out?
If the PEG tube comes out in the early period (the first 4-6 weeks), go to the emergency department immediately; the opening can close within a few hours. In the late period the opening can be kept open with a temporary Foley catheter and a planned replacement performed.
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