Having a Percutaneous

Endoscopic Gastrostomy
PEG
Information for
patients
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This leaflet is designed as a general guide
to your procedure. If after reading this you
have any questions that you feel have not
been answered please contact the relevant
endoscopy department on the number below:

LGI: 0113 392 8675 St James’s: 0113 206 8279

Your doctor has recommended that you have a Percutaneous

Endoscopic Feeding Tube (PEG) fitted. This leaflet will explain
the procedure, how you will need to prepare and what to
expect on the day of the procedure. If you have further
questions, please ask the doctors or nurses on the ward, your
dietitian or you can discuss them with a member of staff on
the day of your procedure.

What is a Percutaneous Endoscopic Gastrostomy-

PEG?
A PEG is a way of introducing food, fluids and medicines directly
into the stomach. A PEG (feeding tube) is placed between the
skin and the stomach. It is inserted
by using a flexible tube with a
camera on the end (gastroscope).
The camera is used to find the best
position for the PEG tube. Once in
position the PEG will be secured
on the surface of the skin with a
fixation device. The procedure takes
approximately 20 minutes.

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Why am I having a PEG?
There are several reasons why you may not be able to eat
normally at the present time. There may be a blockage at
the back of your throat or in your gullet (oesophagus) which
is preventing food going down normally or you may have a
medical condition or illness which is causing you problems with
your swallowing. Sometimes your gullet may not be working
properly for other reasons. Occasionally a PEG tube is inserted
because you are not eating enough to maintain the nutrition
your body needs. A PEG tube bypasses the throat and gullet and
is used for people who have difficulty eating and drinking, or if
there is a risk of the food going “the wrong way” into the lungs.
Although food and fluids can also be given by passing a thin
tube via the nose into the stomach, for people who need tube
feeding for long periods of time, a PEG is more comfortable
and easier to manage at home. A PEG is a means of providing
you with long term feeding and a balanced diet in order to
maintain a good nutritional status.
If you suffer from reflux or regurgitation of food or acid, it
is important that you realise that this problem will not be
improved by having a PEG.
Also, it is important to remember that PEG feeding will not
alter the outcome of your underlying disease or condition.

What are the benefits and alternatives to having a PEG?

A PEG is a safe, reliable and comfortable means of providing
nutrition to people who have long term difficulties
swallowing food.
Alternatives include feeding through a tube placed through
the nose into the stomach, or inserting a tube directly into the
stomach under X-Ray control.

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What are the risks of having a PEG
The risks associated with your PEG insertion will be addressed
by the doctor who discusses the procedure with you. The main
risks are detailed below. It is important that you are aware
and understand the risks before you agree to have a PEG tube
inserted.
•• Having a PEG carries a small risk of a perforation (making
a hole) in your oesophagus (gullet) or stomach from the
gastroscope. There is also a risk that when the PEG tube is
inserted that your bowel could be perforated. If this occurs
and there is leakage of stomach or bowel contents an
operation may be necessary to correct it.
•• Using sedation can affect your breathing. To reduce this risk
we monitor your pulse and oxygen level.
•• Although the PEG tube is inserted using a sterile (aseptic)
technique, there is still a risk of infection around the tube
site. Prior to your PEG insertion you will have specific
preparation that will help to reduce the possibility of an
infection. If a temporary infection should occur a course of
antibiotics may be necessary.
•• A chest infection (also known as pneumonia) can occur
after a procedure like this when sedation has been used for
the PEG tube insertion.
•• You may experience some pain around where the tube has
been inserted. If this is persistent it may be that the fixation
device is too tight. This can be easily altered by the ward staff.
•• Following the procedure you may experience a sore throat.
This should ease after a few days.

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•• Other rare complications include damage to loose teeth,
crowns or to dental bridgework.
These complications occur in about 20% of cases and are
mostly related to infection around the site of the tube and
leakage from around the tube.
A small percentage of patients develop a serious complication
following their PEG insertion. For some patients these
complications can be fatal. Patients with complicated medical
history are more at risk. Your individual risk will be discussed
with you by your doctor.

What preparation will I need?

A PEG insertion must be performed on an empty stomach so
that the endoscopist can see the stomach lining clearly. You
will need to have nothing by mouth for 6 hours prior to your
PEG insertion. If you are being fed through a tube through
your nose you must not have any fluids passed down this for
at least 6 hours.
A blood test will be taken the day before your PEG insertion
to check your blood is clotting normally.
The doctor will insert a small needle into the back of your
hand or in your arm. On the day of your PEG insertion the
endoscopist will use this to give you some sedation. Sedation
is not a general anaesthetic and will not put you to sleep,
however it may make you feel relaxed and possibly a little
drowsy.
You be asked to sign your consent form, you will need to be
aware of the risks (see above) before you complete this form.

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You will have swabs taken from your nose, axilla (underarm)
and groin to check for a bug called “MRSA”. If these swabs
are negative no further action is required. If they are positive
you will be required to use a 5 day course of ointment in your
nose and a liquid medicated soap for your body and hair prior
to your PEG insertion

Do I keep taking my tablets?

You must keep taking any essential tablets. If you are diabetic
or take any blood thinning tablets the ward staff will organise
changes in your medication.

What will happen on the day of my procedure?

Before you leave the ward the nurse taking care of you will
ensure that all your preparation has been completed. You will
be asked to change into a hospital gown.
When you arrive at the endoscopy unit your personal details
will be checked. The assessment nurse will check your medical
history and any allergies. You will be able to ask any questions
and discuss any worries that you have about the procedure.

What happens in the procedure room?

You will be greeted by two nurses who will remain with you
during the test. The two doctors carrying out the procedure
will also be in the procedure room. You will be asked to
remove any dentures or glasses and lay on a trolley on your
left hand side. Pulse rate and the oxygen level in the blood are
monitored by a probe placed on your finger during the test
in all patients. Before the test starts a plastic mouthpiece is
placed between your teeth to keep your mouth slightly open.
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The doctor may spray your mouth with an antiseptic solution
called Chlorhexidine. This reduces the risk of infection as the
PEG tube is passed through your mouth. An antiseptic solution
will also be used to clean the skin on your tummy to reduce
infection. Please tell the doctor or nurse if you are allergic, or
have had skin reactions to antiseptic solutions in the past.
After you have been given your sedation the endoscopist will
gently pass the endoscope to the back of your tongue and
into your stomach, you may gag slightly, this is quite normal
and will not interfere with your breathing. Saliva and other
secretions in your mouth and throat are removed using a
suction tube similar to that used by the dentist.
An antiseptic solution will be used to clean the skin on your
stomach. A local anaesthetic will be used to numb the area
where the PEG tube is to be placed. This may sting initially.
Although you will feel some pressure and some prodding over
your stomach, you should not feel any pain.
When the endoscopist has decided the best position for your
PEG tube with the camera a small cut will be made in your
skin for the PEG tube to pass through. The camera is removed
at this point and replaced by the PEG tube. The position of the
PEG tube is sometimes re-checked so you may be aware of the
camera being passed through your mouth on 2 occasions.
Once in place a small plastic disc inside the stomach stops the
tube from falling out. Sometimes a small dressing is placed
over the tube, but this is not always needed. The dressing will
be removed in 24 hours.

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Minimal restraint may be used during the procedure to
maintain your safety. If you become very uncomfortable the
procedure will be stopped.
Please note: all hospitals in the trust are teaching hospitals
and it may be that trainee endoscopists perform your
procedure under the direct supervision of a consultant or fully
trained registrar.

What happens after the procedure?

You will be transferred to the recovery room after the test.
It is likely that your throat will feel sore and in addition
your stomach may feel a little sore and bloated, this should
settle after a few days. The doctors on the ward will be
able to prescribe some medication for you to help with the
discomfort.
It is important to tell the nursing staff if you have any pain.
You will have your pulse and blood pressure monitored to
ensure there have been no complications. You will then return
to the ward.
The endoscopy unit will give the ward a PEG integrated care
pathway. This document tells you (or the ward nurses) about
how to look after your PEG immediately after it has been
inserted and also long term at home.
This document will be given to you on discharge. You or your
community care team can refer to the guidance it contains
about looking after your PEG tube.

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The following days:
Over the next few hours and days your PEG tube will be
flushed with water and feeds may gradually be introduced.
The area around the PEG will need to be kept clean and dry.
The ward staff/ dietitians will instruct you or your carers how
to manage your PEG tube. The dietitian will organise all you
requirements for your feeding regime.

How long does the PEG tube stay in for?

The life of a PEG tube varies form patient to patient. Your
PEG tube should last for 18 to 24 months. PEG tubes can be
replaced easily if there are signs of “wear and tear”. If your
ability to swallow improves sufficiently for you to be able to
take an adequate amount of food once again, the PEG tube
may be removed.
Your PEG tube can be removed easily by deflating the internal
bumper that holds it in, and pulling the tube out from the
stomach. Repeat gastroscopy is not normally required. Your
clinical team will discuss how your tube will be removed. The
decision to remove your PEG tube will be made only after
discussion with the medical team who are looking after you.

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Questions
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© The Leeds Teaching Hospitals NHS Trust • 2nd edition (Ver 1) Publication date
Reviewed by: Julie Bowen: Nurse Endoscopist 02/2010
Produced by: The Leeds Teaching Hospitals NHS Trust Print Unit • WRU097 Review date
09/2016