A Closer Look at the Surgery to Place a Feeding Tube

A PEG tube—the acronym stands for percutaneous endoscopic gastrostomy—is a silicone rubber feeding tube affixed to a patient’s belly through a simple surgical procedure. Intended for long-term feeding for patients who can’t or won’t eat, the tube carries liquid nutrition directly into the stomach.

Most patients are put under mild sedation for the procedure, along with local anesthesia on the abdomen. Doctors insert a fiberoptic scope through a patient’s mouth, down the throat and into the stomach. The scope transmits images to a monitor, providing a view from inside the stomach that helps guide the surgery. A scalpel is used to make a small incision in the patient’s belly, and the rest of the operation consists mainly of maneuvering delicate equipment in and through and out of the body. The tube is snaked into the stomach and pulled out through the abdominal incision, so most of its length is outside the body, with one end remaining inside the abdominal wall.

In the left image, the PEG tube is the lighter colored tube in both images entering the stomach from the right, and the endoscope is the darker tube. The close-up image on the right, shows how the endoscope lightens the area inside the stomach where the tube lies./Illustration adapted from A.D.A.M. images online, www.adamimages.com, by Lars Headington.

The PEG tube now can deliver nourishment directly into the stomach, typically from plastic pouches of commercially prepared liquid formula, hung on the same poles as those used for intravenous drips. Caregivers also use the PEG tube for fluids and sometimes to administer medicine.

PEG tube placement seldom causes complications, but it does have risks. Possible troubles include uncontrolled bleeding in the stomach, inflammation or infection, and inhaling contents of the stomach into the lungs. Curiously, the prospect that patients with swallowing problems may inhale food into the lungs is often cited as one of the reasons for using a feeding tube. But experts say that with or without a feeding tube, aspiration can occur and pneumonia may result.

A PEG tube may become clogged or dislodged, and stomach contents may leak around the insertion site. A physician wishing to replace a PEG without another surgery must do so immediately, since the hole in the abdomen will close up quickly.

PEGs may stay in for months or even years. If a PEG is deemed no longer necessary, removal is much simpler than the initial surgical placement: A doctor uses “firm traction”—which basically means a hard yank.