Percutaneous Endoscopic Gastrostomy (PEG)

A PEG insertion is a procedure beneficial for patients who have long-term nutritional requirements and cannot take food by mouth. A flexible feeding tube is inserted through the abdominal wall and into the stomach. This allows liquid nutrition products and medications to be put directly into the stomach, bypassing the esophagus. The tube may be temporary or permanent depending on the patient’s condition. The procedure is performed at Forsyth Medical Center by our physicians.

How is the PEG performed?
Your doctor will use a lighted flexible tube called an endoscope to guide the creation of a small opening through the skin of the abdomen and directly into the stomach. This procedure allows the doctor to place and secure a feeding tube into the stomach. Patients generally receive a mild sedative and local anesthesia, and an antibiotic is given by vein prior to the procedure. Patients can usually go home the day of the procedure or the next day.

Who can benefit from a PEG?
Patients who have difficulty swallowing, problems with their appetite or an inability to take enough nutrition through the mouth can benefit from this procedure.

How should I care for the PEG tube?
A dressing will be placed on the PEG site following the procedure. This dressing is usually removed after one or two days. After that you should clean the site once a day with diluted soap and water; keep the site dry between cleansings. No special dressing or covering is needed.

Do I need to take antibiotics?
Antibiotics aren’t generally required before or after EUS examinations. If your doctor feels you need antibiotics, they might be ordered during the EUS examination or after the procedure to help prevent an infection. Your doctor might prescribe antibiotics if you’re having specialized EUS procedures, such as to drain a fluid collection or a cyst using EUS guidance. Again, tell your doctor about any allergies to medications.

What can I expect during an EUS?
Practices vary among doctors, but for an EUS examination of the upper gastrointestinal tract, your endoscopist might spray your throat with a local anesthetic before the test begins. Most often you will receive sedatives intravenously to help you relax. You will most likely begin by lying on your left side. After you receive sedatives, your doctor will pass the ultrasound endoscope through your mouth, esophagus and stomach into the duodenum. The instrument does not interfere with your ability to breathe.
An EUS examination of the lower gastrointestinal tract can often be performed safely and comfortably without medications, but you will probably receive a sedative if the examination will be prolonged or if the doctor will examine a significant distance into the colon. You will start by lying on your left side with your back toward the doctor. Most EUS examinations of the lower gastrointestinal tract last from 10 to 30 minutes.

What happens after an EUS?
If you received sedatives, you will be monitored in the recovery area until most of the sedative medication’s effects have worn off. If you had an upper EUS your throat might be sore, however this can be relieved with nonprescription anesthetic-type throat lozenges and painkillers. You might feel bloated because of the air and water that were introduced during the examination. You’ll be able to eat after you leave the procedure area, unless you’re instructed otherwise.
Your doctor generally can inform you of the results of the procedure that day, but the results of some tests will take longer.

What are the possible complications of an EUS?
Although complications can occur, they are rare when doctors with specialized training and experience perform the EUS examination. Bleeding might occur at a biopsy site, but it’s usually minimal and rarely requires follow-up. Other potential (but uncommon) risks of EUS include a reaction to the sedatives used, backwash of stomach contents into your lungs, infection and complications from heart or lung diseases. One major (but also uncommon) complication of EUS is perforation. This is a tear through the lining of the intestine that might require surgery to repair.
The possibility of complications increases slightly if a deep needle aspiration is performed during the EUS examination. These risks must be balanced against the potential benefits of the procedure and the risks of alternative approaches to the condition.