Percutaneous Endoscopic Gastrostomy (PEG) Procedure

Overview

• PEG is a procedure to insert a feeding tube into the stomach.
• Recommended when a patient cannot take food by mouth for an extended period.

Digestion Process

1. Mouth: Digestion starts with chewing and swallowing.
2. Esophagus: Food travels down this muscular tube to the stomach.
3. Stomach: Further digestion occurs.
4. Small Intestine: Nutrients absorption into the bloodstream.

Indications for PEG Tube Placement

• Conditions that may require a PEG tube:
  • Esophageal cancer
  • Oral surgery
  • Stroke
  • Major surgery
  • Trauma (e.g., burns)
  • Anorexia
  • Inflammation of the pancreas
  • Radiation therapy
  • Inflammatory bowel disease affecting the small intestine

Pre-Procedure Preparation

• Sedation: Patients receive a sedative through IV for relaxation.
• Local Anesthetic: Applied at the abdominal site for the PEG tube placement.

PEG Placement Procedures

Pull Method (Most Common)

1. Endoscope Insertion: A lighted endoscope is inserted through the mouth into the stomach.
2. Needle Insertion: Doctor inserts a needle through the abdomen into the stomach, guided by the endoscope.
3. Wire Snare: A wire snare will encircle the needle’s tip inside the stomach.
4. Wire Passage: A thin wire is passed through the needle into the stomach.
5. Pulling the Tube: The endoscope and wire are pulled out through the mouth, bringing the PEG tube with it.
6. Securing the Tube: A soft round bumper secures the tube inside the stomach, with an outer bumper securing the tube externally.
7. Incision Care: Sterile gauze placed around the incision site.

Push Method (Alternative)

• Similar initial steps, but the PEG tube is pushed directly into the stomach over the wire instead of being pulled through the mouth.

Post-Procedure Care

• IV Fluids: Given for 1-2 days post-procedure.
• Clear Liquids: Introduced through the PEG tube once digestive tract is functional.
• Tube Feeding: Feeding formula administered if clear liquids are tolerated.