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Having a Percutaneous Endoscopic Gastrostomy (PEG)
Because of difficulties with your swallowing or the need to give you extra nutrition, you have been advised to have a percutaneous endoscopic gastrostomy. This is commonly called a PEG.
What is a gastrostomy?
A gastrostomy is an opening into your stomach through the tummy wall. A small feeding tube is fed through this opening so that liquid food can be fed straight into your stomach.
How is this done?
A long, thin (thinner than your little finger) flexible tube called an endoscope is passed through your mouth, over your tongue and into your stomach. Using the endoscope the doctor or nurse can get a clear view of your stomach to find the best place for the feeding tube. Your skin is then numbed with a local anaesthetic and a small cut (about 5 mm / ½ in) is made and the feeding tube is placed in your stomach through this opening.
Before the procedure
On the day of the procedure you must not eat or drink for six hours beforehand to allow a clear view of your stomach during the procedure. The nursing staff on the Endoscopy Unit will ensure that you are
prepared for the procedure and will record your blood pressure and pulse and ask you final for review only routine questions including if you have any allergies or bad reactions to drugs.
Before the procedure can go ahead your written consent will be required and the doctor or nurse specialist will discuss this with you and answer any questions you may have.
In the examination room you will be made comfortable on your bed resting on your left-hand side. A nurse will look after you and stay with you throughout the procedure.
The doctor will give you a sedative injection to help you relax and make you feel sleepy.
The nurse will attach a small clip to your finger to monitor your pulse and general condition during the procedure. Oxygen will be given via plastic tubing under your nostrils. To keep your mouth slightly open, a plastic mouthpiece is placed gently between your teeth.
The procedure may take up to 30 minutes to complete and during this time some air is passed down the tube to inflate your stomach to allow the doctor or nurse a clearer view of the stomach. The air is
sucked out at the end of the procedure. If you get a lot of saliva in your mouth the nurse will clear this using a sucker.
The endoscope is passed twice during the whole procedure. First to find the best place to put the tube in and secondly to check the position of the tube in the stomach once the procedure is done.
After the procedure
You will feel sleepy when you return to the recovery ward. Nursing staff will check your blood pressure, pulse and your tummy where the tube is, at regular intervals. After an hour in the endoscopy recovery ward you will be taken back to your ward and nurses will continue to make the same checks.
A doctor or nurse specialist will see you on the ward after the procedure and will examine you and listen to your tummy through a stethoscope. Once the doctor has examined you he or she will let the
nurses and you know when you can start to eat and drink (if you do not have a swallowing problem) and also that they can start to use the tube. The nurses will put water through the tube for the first six hours before starting the feed. The dietitian will have given the nurses your feed plan.
You may experience a sore throat for the rest of that day. Sometimes you may feel a little bloated and this is caused by some of the air remaining in your stomach. You may experience some pain around the tube site – tell the nurses if you are in pain so they can help you.
There may be a slight risk to crowned teeth or bridgework and you should tell the doctor or nurse if you have any of these.
All endoscopies carry a very slight risk of damaging the lining of your gullet, stomach or small intestine.
Infection around the tube insertion site can occur and the risk of this is minimised by giving you antibiotics before the procedure.
Chest infections (pneumonia) can occasionally occur after the procedure.
Other rare complications include making a hole (perforation) in the bowel at the insertion site – if this happens an operation may be needed to repair it. There could be a reaction to the sedative drugs given but again this is rare.
Bleeding could occur as the skin is being cut. The risk of this is minimised by taking blood tests and checking the results before the procedure.
In all cases the appropriate treatment will be given.
Looking after your PEG
Before you go home you and / or your carers will be shown how to look after the site, the tube and also how to give feeds through the tube. You will be supported by the nursing staff on the ward, the dietitians and nutrition nurse to do this.
Further written information about looking after your PEG will be given to you during this time.
On discharge you will be supported by the dietitians who will regularly monitor your progress.
If you have any further questions about the procedure or afterwards your doctor, the nutrition nurse or nursing staff will be pleased to answer them.
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