Isaac O. Opole, MD, PhD, is a board-certified physician specializing in geriatric medicine.He has practiced for over 15 years at the University of Kansas Medical Center where he is also a professor.
Percutaneous endoscopic gastrostomy is a procedure in which a flexible feeding tube (called a PEG tube) is inserted through the abdominal wall into the stomach.For patients who cannot swallow food on their own, PEG tubes allow nutrients, fluids and medications to be delivered directly into the stomach, eliminating the need to bypass the mouth and esophagus for swallowing.
Feeding tubes are helpful for people who are unable to feed themselves due to acute illness or surgery but have a reasonable chance of recovery.They also help people who are temporarily or permanently unable to swallow but are functioning normally or close to normal.
In this case, a feeding tube may be the only way to provide much-needed nutrition and/or medication.This is called enteral nutrition.
Before you have a gastrostomy, your healthcare provider will need to know if you have any chronic health conditions (such as high blood pressure) or allergies and the medications you take.You may need to stop certain medications, such as blood thinners or non-steroidal anti-inflammatory drugs (NSAIDs), until the end of surgery to minimize the risk of bleeding.
You will not be able to eat or drink for eight hours before the procedure and arrangements should be made for someone to pick you up and drive you home.
If a person cannot eat and does not have the option of a feeding tube, the fluids, calories, and nutrients needed for survival can be provided intravenously.Often, getting calories and nutrients into the stomach or intestines is the best way for people to get the nutrients their bodies need to function optimally, so feeding tubes provide better nutrients than IV fluids.
Before the PEG placement procedure, you will receive intravenous sedation and local anesthesia around the incision site.You may also receive intravenous antibiotics to prevent infection.
The healthcare provider will then place a light-emitting flexible tube called an endoscope down your throat to help guide the actual tube through the stomach wall.A small incision is made to place a disc inside and outside the opening in the abdomen; this opening is called a stoma.The portion of the tube outside the body is 6 to 12 inches long.
After surgery, your surgeon will place a bandage on the incision site.You may experience some pain around the incision area after surgery, or cramping and discomfort from gas.There may also be some fluid leakage around the incision site.These side effects should subside within 24 to 48 hours.Usually, you can remove the bandage after a day or two.
Getting used to the feeding tube takes time.If you need a tube because you can’t swallow, you won’t be able to eat and drink through your mouth.(In rare cases, people with PEG tubes can still eat by mouth.) Products designed for tube feeding provide all the nutrients you need.
When you’re not using it, you can tape the tube to your stomach with medical tape.A stopper or cap on the end of the tube prevents any formula from leaking onto your clothing.
After the area around your feeding tube has healed, you will meet with a dietitian or nutritionist who will show you how to use the PEG tube and begin enteral nutrition.Here are the steps you will follow when using PEG tubes:
In some cases, it can be difficult to determine if feeding a person a tube is the right thing to do and what the ethical considerations are.Examples of these situations include:
If you or a loved one is seriously ill and unable to eat by mouth, PEG tubes can temporarily or even permanently provide the body with heat and nutrients to heal and thrive.
PEG tubes can be used for months or years.If necessary, your healthcare provider can easily remove or replace the tube without the use of sedatives or anesthetics by using firm traction.After the tube is removed, the opening in your abdomen closes quickly (so if it comes off accidentally, you should call your healthcare provider right away.)
Whether tube feeding improves quality of life (QoL) depends on the reason for the tube feeding and the patient’s condition.A 2016 study looked at 100 patients who received feeding tubes.After three months, patients and/or caregivers were interviewed.The authors concluded that while the tubes did not improve the patients’ quality of life, they did not decline.
The tube will have a mark showing where it should be flush with the opening in the abdominal wall.This can help you confirm that the tube is in the correct position.
You can clean the PEG tube by flushing warm water through the tube with a syringe before and after feeding or receiving medication, and cleaning the ends with disinfecting wipes.
First, try flushing the tube as usual before and after feedings.If the tube is not flushed or the feeding formula is too thick, clogging can occur.Call your healthcare provider if the tube cannot be removed.Never use wires or anything else to try to unclog the tube.
Subscribe to our daily health tips newsletter and receive daily tips to help you live your healthiest life.
American Society of Gastrointestinal Endoscopy.Learn about percutaneous endoscopic gastrostomy (PEG).
Ojo O, Keaveney E, Wang XH, Feng P. Effects of enteral tube feeding on health-related quality of life in patients: a systematic review.nutrients.2019;11(5).doi: 10.3390/nu11051046
Metheny NA, Hinyard LJ, Mohammed KA.Incidence of sinusitis associated with trachea and nasogastric tubes: the NIS database.Am J Crit Care.2018;27(1):24-31.doi:10.4037/ajcc2018978
Yoon EWT, Yoneda K, Nakamura S, Nishihara K. Percutaneous endoscopic gastrojejunostomy (PEG-J): a retrospective analysis of its utility in maintaining enteral nutrition after unsuccessful gastric feeding.BMJ Open Gastroenterology.2016;3(1):e000098corr1.doi: 10.1136/bmjgast-2016-000098
Kurien M, Andrews RE, Tattersall R, et al.Gastrostomy is preserved but does not improve the quality of life of patients and caregivers.Clinical Gastroenterology and Hepatology.2017 Jul;15(7):1047-1054.doi:10.1016/j.cgh.2016.10.032
Post time: Jun-28-2022