Stoll of Those on Peg Tube Feedings
Key takeaways:
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A percutaneous endoscopic gastrostomy (PEG) tube is a feeding tube that goes into the stomach through the skin. It provides a means for nutrition and medication when someone can't swallow or eat well.
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The placement of a PEG tube is a safe procedure, but there's some risk. Severe complications are rare and most issues are minor.
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A PEG tube can stay in place for many months to years, but it isn't permanent. A provider can remove it when someone no longer needs it and they can eat by mouth again.
It's hard to imagine getting the nutrients you need without eating or drinking by mouth. So it can be scary to find out that you or a loved one may need a percutaneous endoscopic gastrostomy (PEG) tube. But a PEG tube is a safe substitute for providing nutrients when getting enough food or fluids by mouth isn't an option.
What is a PEG tube?
A PEG tube is a feeding tube that goes from the skin into the stomach. It provides nutrients, fluids, and medications to someone who can't swallow or eat well. Since the name is a mouthful, we'll breakdown the acronym into its parts:
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Percutaneous means the tube goes through the skin.
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Endoscopic means the doctor will use an endoscope to place the tube. This is a small camera with tools that goes into the mouth and down the esophagus to help put the tube in place.
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Gastrostomy refers to any kind of opening a provider creates in the stomach wall.
A healthcare provider places a PEG tube in a hospital or surgical center. They can teach someone with a PEG tube and their family members how to manage it at home.
Why would someone need a PEG tube?
A person might need a PEG tube if they have a condition that makes it difficult to swallow or eat enough calories. Some common reasons include:
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Cancer, surgery, or radiation of the throat and esophagus
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Long stays in the hospital or intensive care unit (ICU)
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Traumatic head injury
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Stroke
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Multiple sclerosis
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Dementia
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Coma
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Amyotrophic lateral sclerosis (ALS)
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Parkinson's disease
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Cystic fibrosis
How safe is it to place a PEG tube?
The procedure for inserting a PEG tube is safe and not very invasive. Sometimes a provider can do it in an outpatient endoscopy center. In this case, you can go home the same day. Sometimes PEG tube placement happens in a hospital, and a healthcare team observes you overnight. The success rate for PEG tube placement is nearly 100%.
There are some situations in which a provider can't safely place a PEG tube. These include:
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Gastroparesis (the stomach doesn't empty well)
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Cancer around the stomach
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Ascites (extra fluid in the abdominal cavity)
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Bleeding disorders
While PEG tubes can be necessary for adequate food intake, they require consistent care and cleaning. If someone can't use and clean the PEG tube on their own, they'll need assistance from a care team.
What are the complications of having a PEG tube?
Although the PEG tube procedure is safe, it does have a risk of some complications. Complications can happen during or after the procedure. Fortunately, major complications are rare. But minor complications can happen up to 25% of the time.
Major complications can include:
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Bleeding
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Damage to a nearby organ (like the liver or colon)
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Infection of the deep tissue around the tube, belly, or lungs
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Reactions to the anesthesia
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Spread of tumor cells (in those with cancer)
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Buried bumper syndrome (a piece of the PEG erodes through the stomach)
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Death
Minor complications can include:
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Skin infection near the tube
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Change in position of the tube (falling out or being pulled out)
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Stomach fluid leaking around the tube
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Pain
How do feedings work with a PEG tube?
Someone with a PEG tube gets tube feeds continuously or a few times during the day in a "bolus." For a continuous feed, a provider hangs a bag of nutrients on a pole and connects tubing to the PEG. A certain amount of liquid goes into the stomach every hour, with the help of gravity or a pump. Someone with continuous feeds often gets them overnight for several hours. That way they aren't connected to tubing during the day.
For people with a bolus feeding schedule, a large amount of nutrients is pushed into the PEG tube with a syringe. This occurs a few times per day at each mealtime. A provider may assist with this in the hospital or clinic, but someone with a PEG tube may also learn to do this. A benefit of the bolus is that the person isn't connected to tubing for extended periods of time.
There are many different formulas for tube feedings. A nutritionist can find the right product for each person based on their nutritional needs.
Are there dietary restrictions for people with feeding tubes?
Having a PEG tube doesn't stop you from eating — if you can swallow safely. Healthcare teams often encourage people with PEG tubes to eat and drink what they can through their mouth. In these cases, the PEG tube can make up any extra calories and nutrition the person may need.
But a person with a PEG tube may have a medical condition that makes it unsafe to swallow food. For example, someone who chokes when eating may need to avoid swallowing food or liquids.
Is a PEG feeding tube permanent?
No, it isn't permanent. A trained healthcare provider can remove a PEG tube when you no longer need it or the tube needs to be replaced. The method of removal depends on the type of PEG tube.
Experts are still debating how long a PEG tube can stay in place. If you need a PEG tube for the long term, it can stay in place for months to years before you need to replace it.
You may need to replace a PEG tube if the tube breaks or it gets clogged or dislodged.
Is a PEG tube a form of life support?
In some situations, artificial nutrition with a PEG tube can be a type of life support. If a person has a condition where they wouldn't survive without tube feeding, a PEG tube is supporting life. This is the case with a persistent vegetative state where the person isn't conscious or able to eat.
Healthcare teams and families may consider a PEG tube for someone with advanced dementia who can't eat. But feeding tubes don't prolong or improve the quality of life in people with dementia. Speaking with a healthcare provider can help you weigh the risks and benefits of a PEG tube.
Should I worry if a loved one needs a feeding tube?
A PEG tube can be an essential part of a loved one's recovery from surgery or illness. It's a safe way to get necessary nutrition and medications. In some progressive or incurable conditions, the need for a PEG tube can be a sign of advanced disease. It's important to discuss your concerns with a healthcare provider.
The bottom line
A PEG tube provides a means for adequate nutrition and medication in a variety of conditions and circumstances. Although someone may need to use a PEG tube for the long term, it isn't a permanent procedure. A trained provider can replace or remove it when needed. It's normal to be a little anxious about the need for a PEG tube. But a healthcare provider can help you weigh the risks and benefits.
Gramlich, L., et al. (2018). Home enteral nutrition: Towards a standard of care. Nutrients.
Kitzinger, J., et al. (2018). Deaths after feeding-tube withdrawal from patients in vegetative and minimally conscious states: A qualitative study of family experience. Palliative Medicine.
MedlinePlus. (2022). Bleeding disorders.
Rahnemai-Azar, A. A., et al. (2014). Percutaneous endoscopic gastrostomy: Indications, technique, complications and management. World Journal of Gastroenterology.
Schneider, P. L., et al. (2021). Ethical considerations concerning use of percutaneous endoscopic gastrostomy feeding tubes in patients with advanced dementia. The Permanente Journal.
Vudayagiri, L., et al. (2021). Percutaneous endoscopic gastrostomy tube. StatPearls.
Zouk, A. N., et al. (2021). Managing complications of percutaneous tracheostomy and gastrostomy. Journal of Thoracic Disease.
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