Percutaneous Endoscopic Gastrostomy (PEG)

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PEG Overview

• What is a PEG?

  A PEG is a tube doctors can put from the skin of the belly into the stomach. This is helpful for people who don’t get enough food because of health problems like stroke, cancer, or weakness.

• Who needs a PEG?

  A PEG tube can be helpful for children and adults that are unable to safely consume enough food to meet their nutritional needs, and are still able to digest food in their stomach and intestines.

  Some health problems that require PEG tubes are:

  • Stroke
  • Cancer of the mouth or neck
  • Weakness of the mouth or neck muscles

  When someone is being considered for a PEG tube placement, their life expectancy and quality of life after the tube is placed are always assessed to see if the procedure is appropriate.

• How is a PEG tube put in?

  It takes about 15-20 minutes to put in a PEG tube.

  1. The doctor gives the patient medication to make them sleepy and comfortable.
  2. The doctor puts a small camera into the patient’s mouth that then goes into the stomach. They use this to find the best place on the patient's belly to put the tube.
  3. The doctor makes a small cut in the skin.
  4. The doctor then carefully puts the PEG tube through the skin and into the stomach.

  The procedure usually takes 15-20 minutes.

• Is there discomfort after the procedure?

  There will be some minimal discomfort after the procedure from either cramping from gas in the digestive system or pain at the incision site itself. This pain can be well controlled with pain medication if required.

• Does it hurt to put a PEG tube in?

  There is very little pain after the procedure. Patients can have some belly pain around the tube. Usually, any pain goes away within a few days.

• Will the tube fall out after it is put in?

  No.

  1. Some tubes have a rubber ring that sits in the stomach to hold them in place.
  2. Some tubes have a small balloon in the stomach to hold them in place.
• What is the PEG tube going to look like after it is put in?

  The PEG tube will look like a small, plastic tube about the size of a pencil that comes out of the skin on the belly. There will be a small rubber cap around the tube that stays on the skin to help keep it in place. The end of the tube will have a cap with one or two holes and a cap. Patients can use special tools to put in or remove food and water through this cap.

• What might go wrong with a PEG tube?

  There can be some problems with putting in the tube or with the tube after it is put in. Minor problems include:

  • Food or water leaking out of the stomach around the tube
  • Pain where the tube is put in
  • Skin bleeding
  • Skin infections

  Major problems are not common but include:

  • Bleeding inside the belly
  • Infection inside the belly
  • Damage to other parts of the belly

  If any of these happen, please let your doctor know right away.
• Are there other options besides a PEG?

  Yes

  1. Nasogastric (NG) tubes are long tubes that pass through the nose and into the stomach. These are only used for a short time because long-term use can cause pain, infection, and bleeding in the nose or throat.
  2. Nasogastric (NG) tubes are long tubes that pass through the nose and into the stomach. These are only used for a short time because long-term use can cause pain, infection, and bleeding in the nose or throat.
  3. Jejunostomy tubes are like PEG tubes except they connect the skin and the small intestine (instead of the stomach).
• How do you take care of a PEG tube?
  • Clean the skin around the tube every day and cover with clean gauze.
  • Watch the marking on the side of the tube to make sure it stays in the same place.
  • If the marking changes, adjust the tube to put it back in the right place.
  • Don’t place the rubber cap too tightly on the skin.
  • If the tube falls out, call your doctor right away or go to your closest emergency room.
  • Never remove a PEG tube yourself without talking to your doctor first.
• What can you put into the PEG tube?

  ONLY prescription formula, water, and medications should be put into a PEG tube. After the tube is put in, a nutritionist, nurse, pharmacist, or physician will figure out what formula is the best for each individual patient. This allows every patient to get the right amount of calories, vitamins, and minerals.

• How is a PEG tube used for feeding?

  After the PEG tube is put in, a nutritionist or nurse will go through exactly how to use the tube. Special tools are needed to put the formula or water into the PEG tube. The tube must also be flushed with water after every use to avoid clogging.

  Sometimes, pumps are used to give a small amount of formula, continuously, over a long time. Nutritionists or nurses will determine how fast to give the formula for each patient.

• Can I put medications through a PEG tube?

  Yes. You will need to crush tablets in water before putting them into the tube. You cannot put capsules into the tube. You will need to put water into the tube after you put medications through it to wash it properly.

• Is a PEG tube permanent?

  Depends. If a patient starts feeling better and can start eating and drinking enough food and water, then the tube can be removed. If the patient is not able to do this, the tube can be used long-term..

• Do PEG feeding tubes last forever?

  The lifespan of the PEG feeding tube is about 1 year although the tube may wear out sooner. When the tubing begins to wear, you will notice pits, bumps and leaks on the side of the tube. In addition, the feeding tube cap may split or fail to close properly. You should notify your physician if this develops.

• How long does a PEG last?

  About 1 year. Around a year, the tube will start to wear out and problems can start to happen. The tube can also start to get clogged. If this happens, call your doctor. Doctors can usually change out the tube for another one.

• How do you take out the PEG tube?

  This should only be done by a doctor or nurse.

  • Some tubes can be removed just by pulling on the tube. This can cause some temporary pain.
  • Some tubes have a balloon on the inside that needs to have air or water taken out before the tube is removed.

Author(s) and Publication Date(s)

Mark DeLegge, MD, FACG, Digestive Disease Center, Medical University of South Carolina, Charleston, SC and Bruce T. Kalmin, MD, Atlanta Gastroenterology Associates, Atlanta, GA – Published November 2007.

Bruce T. Kalmin, MD, Atlanta Gastroenterology Associates, Atlanta, GA – Updated December 2012.

Abhinav Vemula, MD, Boston Medical Center, Boston, MA – Updated July, 2021.

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