Is PEG Tube Placement a Major Surgery?

A percutaneous endoscopic gastrostomy (PEG) tube placement is a method of placing a small, flexible tube (gastrostomy tube) into the stomach through the skin (percutaneously) with the help of an endoscope (a flexible tube with a camera and a light on one end). PEG tube placement is one of the most performed endoscopic procedures in the United States. 

A gastrostomy tube is a small, flexible tube that passes through the abdominal wall into the stomach. It is held in place by the sutures.

A percutaneous endoscopic gastrostomy (PEG) tube is a gastrostomy tube placed into the stomach with the help of an endoscope. Percutaneous insertion means through the skin.

Percutaneous endoscopic gastrostomy (PEG) tube placement surgery may be performed in the following cases:

Patients who are unable to move food from their mouth to their stomach are the ones who usually need a PEG tube placement. This includes people who have:

• Stroke
• Cerebral palsy
• Brain injury
• Amyotrophic lateral sclerosis (motor neuron disease)
• Impaired swallowing
• Injury
• Cancer
• Recent surgery on the stomach or bowel

Patients who need gut decompression because of inadequate drainage of gut contents:

• Abdominal cancers
• Stomach outlet obstruction
• Bowel obstruction
• Diseases of gut muscles that impair emptying (e.g., gastroparesis)

You will stay in the hospital at least overnight after the PEG placement. The GI or anesthesia office will call with instructions before your procedure day.

• Before the procedure, you will be instructed to not eat or drink anything for a few hours. 
• The procedure is generally performed with moderate to deep IV (intravenous) sedation along with local anesthesia at the site of tube placement.
• You will lie on the bed with the head end of the bed elevated at a 30° angle to reduce the risk of aspiration (accidental entry of food/fluids into the windpipe).
• The anesthesiologist administers anesthesia and monitors your pulse and blood pressure.
• The antibiotics are administered intravenously.
• The doctor passes an endoscope (a flexible tube with a camera and a light on one end) through the mouth, throat, and food pipe (esophagus) into the stomach. 
• When the endoscope reaches the stomach, its light can be seen on the surface of the patient’s abdomen. This spot is used for tube insertion.
• The fluid from the stomach is suctioned out through the endoscope.
• The doctor sterilizes the skin, injects numbing medicine (local anesthesia), and makes a small surgical cut (incision) about 1 cm in size. 
• The PEG tube is pushed into the stomach through the cut.
• The PEG tube is secured in place with the help of sutures.
• The tube is kept in place on the inside by a plastic bolster or a water-filled balloon bolster and on the outside by a small plastic disc that is placed on the surface of the abdomen.
• The PEG tube is flushed and suctioned before completion of the procedure to ensure patency while you are still sedated.

The complications of a percutaneous endoscopic gastrostomy (PEG) tube placement procedure include:

• Peritonitis (inflammation of the abdominal cavity)
• Bleeding
• Pneumoperitoneum (entrapment of air in the peritoneum–the inner lining of the abdomen that envelops most of the organs in the abdomen)
• Stomach outlet obstruction
• Conditions related to the heart and lungs due to oversedation
• Allergies to the sedatives or antibiotic administered
• Aspiration (a serious condition in which food, liquid, or body secretion enters the airways or the lungs by accident)
• Infections at the site of tube (cellulitis)
• Peristomal leakage (leakage of stomach contents around the gastrostomy site)
• Delayed emptying of the stomach/bowel
• Bowel perforation
• Stomach wall ulceration (with longstanding PEG tubes)
• Accidental PEG tube removal (by an agitated or confused patient)
• Colocutaneous fistula (abnormal communication path between the skin and the large bowel)
• PEG tract tumor seeding