Reasons to Perform PEG
• swallowing dysfunction

PEG

 

 

 

Patient Information on PEG

 

Percutaneous endoscopic gastrostomy (PEG) feeding tubes were first described in 1980. Early studies typically demonstrated it to be an easy and safe technique when compared with the available alternatives such as open gastrostomy. PEG feeding tubes are increasingly used for long term enteral nutrition. It is used where patients cannot maintain adequate nutrition with oral intake.

Neurological conditions are most commonly associated with such disability and constitute the most common indication for PEG. Its simplicity has led some to concern about use when there is little or no clinical benefit.

Care needs to be taken when looking at studies on use of PEG as there are differences in patient selection which affect for example outcome measures and complications. There are sometimes ethical factors to consider (see below). Several court cases have considered use of PEG feeding in patients who have lost the capacity for self determination.

PEG insertion method

  • Can be done as an outpatient procedure
  • Takes on average less than 20 minutes
  • Requires sedation and upper GI endoscopy
  • Can be with either 'push' or 'pull' insertion
  • 'Pull' insertion more usual and best given with antibiotic prophylaxis
  • PEG tubes are made of polyurethane or silicone with a retaining mechanism
  • For feeding longer than 1 month a silicone button (flush with the skin) is used
  • Retained usually with intragastric balloon
  • Can be done by suitably trained and supervised nurse practitioners
  • Antibiotic prophylaxis now usually recommended

Benefits of PEG feeding

  • Well tolerated (better than nasogastric tubes)
  • Improved nutritional status
  • Ease of usage over other methods (nasogastric or oral feeding) reported by carers
  • Satisfactory use by home carers
  • Low incidence of complications
  • Reduction in aspiration pneumonia associated with swallowing disorders
  • Cost effective relative to alternative methods particularly when reasonably long survival expected

Complications

Morbidity and mortality are generally considered to be low with studies reporting major complications between 3% and 8% of patients and minor in around 14%. Mortality from the procedure itself is very low and less than 1%. However other studies report higher and rising complication rates. These often relate to the underlying illnesses with for example higher rates of wound infections in malignant disease and may also reflect a lowered threshold for PEG insertion.