Makindo Medical Notes

A Percutaneous Endoscopic Gastrostomy (PEG) is a feeding tube inserted directly into the stomach through the abdominal wall using an endoscope. It is indicated when a patient cannot maintain adequate oral intake due to conditions such as stroke with dysphagia, oesophageal/head & neck cancers, neurodegenerative disorders (MND, MS, Parkinson’s) or severe trauma. 💡 Clinical pearl: In the UK, PEG is the standard method for long-term enteral feeding when endoscopic access is possible and sedation is safe.

🛠️ Procedure Overview

1. Preparation:
   • Patient is sedated or given local anaesthetic with conscious sedation.
   • An endoscope is introduced through the mouth into the stomach to allow direct visualisation.
   • Stomach is insufflated with air → helps appose the gastric wall to the abdominal wall.
2. Insertion of the Tube:
   • A small abdominal incision is made at the transillumination point.
   • A hollow needle punctures the stomach, and a wire or thread is passed through the endoscope.
   • The feeding tube is pulled into position via the “pull” or “push” technique.
   • The internal bumper secures the tube inside the stomach, and an external flange fixes it to the skin.
3. Post-Procedure Care:
   • Insertion site is cleaned and dressed.
   • Monitor for infection, bleeding, leakage or dislodgement.
   • Feeding can usually start within 12–24 hours once placement is confirmed.

🌟 Benefits of PEG

• ✅ Minimally invasive with relatively quick recovery.
• ✅ Provides long-term nutritional support.
• ✅ Can improve quality of life in chronic neurological or malignant conditions.
• ✅ Usually better tolerated than nasogastric tubes for prolonged use.

⚠️ Risks and Complications

• 🦠 Infection at the insertion site (commonest complication).
• 💉 Bleeding, injury to abdominal viscera (rare but serious).
• 🔄 Tube blockage, leakage, or dislodgement.
• ⚡ Aspiration pneumonia during sedation or early use.
• 📉 Peritonitis if gastric contents leak into peritoneum.
• ⚠️ Rare: buried bumper syndrome (internal fixation eroding into stomach wall).

💡 Clinical pearl: Always assess for suitability of sedation and endoscopic access. PEG is preferred when feasible, but RIG is an alternative if endoscopy or sedation is unsafe (e.g. advanced MND with poor respiratory reserve).

PEG vs RIG: Comparison

💡 Teaching Tip: In the UK, PEG is standard for long-term enteral feeding. Use RIG if endoscopy is not possible or unsafe. Always discuss with MDT (gastroenterology, radiology, dietetics, speech therapy) before insertion.