Feeding Tubes for Nutritional Support
Percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic transgastric jejunostomy (PEG-J) are endoscopic approaches for the placement of feeding tubes in patients who are unable to consume food adequately by mouth. In a PEG procedure, a feeding tube is inserted through the abdominal wall and directly into the stomach. In a PEG-J procedure, an extension is added to the tube, placing it in the small intestines. Bypassing the need for oral ingestion, PEG and PEG-J feeding tubes deliver vital nutrition, fluids and medications directly to the stomach or small intestines.
PEG or PEG-J procedures are an effective feeding alternative for those who have trouble with swallowing, have a weak appetite or cannot get adequate nutrition orally. The PEG-J is especially helpful for patients with acute or chronic pancreatitis — ensuring that the body receives proper nutrition while allowing the pancreas to rest.
In a PEG procedure, your doctor will guide a thin, flexible tube called an endoscope through your mouth and into the stomach. An attached light source in the tip of the endoscope is used to help make a small opening (incision) in the skin of your abdomen through which the feeding tube is placed into the stomach. The PEG-J procedure follows the same process, routing a longer feeding tube through the stomach and into the small intestines.
Patients undergoing these procedures will be placed under sedation, receiving local anesthesia and an intravenous antibiotic before the procedure. Typically, patients can go home the same day or the following day after the procedure.
After the procedure, your abdomen will be bandaged at the site where the feeding tube was inserted. This covering will typically be removed in one to three days. From that point, the feeding tube site should be cleaned daily with diluted soap water and kept dry.
A specially made nutritional formula as well as liquids are delivered through the feeding tube. Some PEG patients may be able to eat or drink after the procedure, but it is very important to get permission from your physician first, particularly if there is a risk for aspiration, as in stroke patients. Some patients getting a PEG-J feeding tube for acute or chronic pancreatitis may be able to take clear liquids along with tube feeds. Be sure to talk with your gastroenterologist before having anything to eat or drink by mouth.
Generally, endoscopic procedures are very safe. While rare, complications from a PEG or PEG-J procedure may occur and can include:
- Pain or an infection at the incision site
- Stomach contents leaking from around the feeding tube site
- Feeding tube malfunctioning or becoming dislodged
- Bleeding or perforation caused by a hole forming in the bowel
Note: If your feeding tube falls out, contact your doctor right away.
Depending on the initial reason for placement, a feeding tube can last for months or even years. From time to time, tubes may need to be replaced due to clogging or just breaking down from normal usage. Tube replacement requires another endoscopic procedure, which usually is of a shorter duration. Your doctor will remove the tube either with firm traction or by cutting it free. A replacement tube will then be inserted, or, if a new tube is not needed, the opening (incision site) will be allowed to close on its own.
