The placing of a PEG feeding tube is a surgical procedure. The name percutaneous endoscopic gastroscopy already reveals a lot about the procedure. An endoscope is used to perform a stomach endoscopy (gastroscopy). It also passes through the skin (percutaneous). The procedure is carried out in the endoscopic department of a hospital. The person receiving a PEG must be fasting, i.e. must not have eaten anything.
Preparations
As PEG placement is a standard procedure, most of the specialist doctors involved have a lot of practice in it. As a result, they are generally very relaxed. In contrast, people are correspondingly excited when they receive a PEG for the first time. Patients usually lie down during the procedure. The room is darkened to make it easier to work on the video screen of the endoscope.
The patient is given an intravenous cannula. This is because the patient is sedated during the procedure. The drugs of choice for this are Midazolam or Propofol. More about their mode of action elsewhere. If necessary, the sedation is increased or renewed during the treatment. While it is still starting to take effect, a bite guard is placed between the teeth. This keeps the mouth open and allows the necessary instruments to be inserted later without difficulty.
Placement
To prevent a gag reflex being triggered, the throat is anaesthetised with a local anaesthetic spray. You already do not notice anything of this. The endoscope is then passed through the mouth and oesophagus into the stomach. This is then filled with air so that the stomach walls are smooth. It is then easier to determine the best place to insert the PEG. A small light on the endoscope then shines through the skin of the abdominal wall from the stomach. The doctor then knows where to make a small incision, only a few millimetres long, through the skin and stomach wall. A plastic tube is inserted into the incision channel using a steel cannula. This creates a connection through the skin into the stomach. A suture is then inserted through this. This is grasped with a small endoscope forceps and pulled back. Out of the mouth. The tube of the gastric tube is then tied there. This tube is then pulled into the stomach by the thread and then through the incision channel. The plastic tube is then replaced by the feeding tube. A small plastic plate at the inner end of the feeding tube prevents it from being pulled out.
Finalisation
The tube of the PEG feeding tube is also secured from the outside with a plastic retaining plate so that it does not slip too far back into the stomach. During the initial placement, the two plates are held fairly tightly so that the punctured layers of the stomach wall and skin grow together well and a firm puncture channel is formed.
Finally, the wound is bandaged together with the gastric tube. The endoscope and the bite guard are removed. As the effect of the anaesthetic medication wears off over time, the new owner of the PEG feeding tube wakes up soon afterwards in the recovery room.
You can read about what happens in the first few days after the PEG placement in my next post.
