If a patient needs to be artificially fed, this should always be done via the gastrointestinal tract if possible.
Feeding tubes that are inserted into the stomach via the nose or mouth can only be left in place for a short time. If enteral (artificial) feeding is required for longer than 2-3 weeks, it is advisable to insert a PEG tube. The tube is inserted into the stomach from the outside through the skin(percutaneously). It can remain there for months to years.
Doctors use PEGtubes when patients are unable to feed themselves (sufficiently) normally over a longer period of time @ Martha Kosthorst /AdobeStock
There are many different indications for a percutaneous endoscopic gastrostomy, e.g.
The decision must be weighed up critically and the individual course and prognosis of a patient must always be taken into account.
Gastroenterology is a branch of internal medicine that deals with the diagnosis and treatment of diseases of the human digestive tract. A gastroenterologist is a specialist in internal medicine and has completed further training in the field of gastroenterology.
There are different methods for placing a feeding tube through the abdominal wall. A percutaneous endoscopic gastrostomy is performed under sedation (anesthetic injection) or short anesthesia in the endoscopy department with appropriate monitoring.
It is recommended that antibiotics are administered via the vein shortly before the PEG is inserted. The abdomen is disinfected and sterilely draped.
First, a gastroscopy is performed to rule out any relevant diseases or narrowing of the stomach.
Air is then introduced into the stomach via the gastroscope in order to find the optimal puncture site in a darkened room. After local anesthesia, a small incision is made in the abdominal wall and the puncture is made with a hollow needle. A guide thread is placed over it, which is grasped from the inside with endoscopy forceps and then passed out through the mouth.
The probe is fixed to the thread. The second examiner now pulls back the guide thread from the puncture site and can guide the PEG tube through the opening. The percutaneous endoscopic gastrostomy is secured in the stomach by a plate to prevent it from slipping out. Adapters are then connected and a sterile dressing is applied.
If constrictions in the pharynx, throat or oesophagus make it impossible to insert the PEG tube, a different procedure must be used.
The gastroscopy is performed with a thinner endoscope and the search for the optimal puncture site is carried out as described above.
However, the stomach is then first fixed to the anterior abdominal wall with 2-3 sutures using a special suture apparatus (gastropexy system). A trocar (puncture instrument) with a sleeve is then used to puncture in between and a balloon catheter is placed. Here, a balloon protects the PEG tube from slipping out.
An additional tube is inserted via the horizontal PEG (must have a size of 15 Charrière), which is then advanced into the small intestine (jejunum) using an endoscope.
This method enables nutrition directly via the small intestine and thus relieves the stomach if necessary.
This is necessary for
If it is not possible to puncture the stomach, the small intestine can also be punctured directly. This is necessary after stomach and esophageal surgery, for example. The technique is the suture pull-through method as used for PEG insertion.
Four weeks after the puncture, you can switch to a second system. So-called button systems are small balloon systems that are very small and inconspicuous on the outside.
This is indicated for children and patients who are still very mobile and independent, but is also an option for local wound problems. The tube can be used on the same day as the procedure, usually initially with water or tea, and the diet can be built up with liquid food after a few days. Showering and bathing are also no problem during the procedure.
Injuries and/or perforation of the throat, oesophagus, stomach and intestine can occur during PEG insertion. Neighboring organs and vessels can also be injured as a result of an incorrect puncture. This in turn can lead to bleeding and infections, e.g. peritonitis. In an emergency, this requires immediate surgery.
Otherwise, the risks associated with a PEG are the same as with a gastroscopy.
The further course of the procedure is highly dependent on adequate care and handling of the tube system.
Typical complications during the course of the procedure are
In the first week, a daily dressing change is necessary, then only 2-3 times a week, depending on the condition of the skin. Later, the PEG tube can be left in place without a dressing. The PEG tube must be rinsed regularly with water or tea after each tube feed and after each dose of medication.
The holding plate should be mobilized 1-2 times a week to prevent it from growing into the stomach wall. This is often forgotten and, in combination with a too tight external fixation, often leads to the so-called buried bumper syndrome.
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