P.E.G. (Percutaneous Endoscopic Gastrostomy)

P.E.G. (Percutaneous Endoscopic Gastrostomy) Tube Placement - this is the procedure of choice for patients who are unable to swallow due to neurological disorders such as stroke or mental retardation, or patients who are unwilling or unable to maintain nutritional intake due to sever debilitation.

The patient undergoes an EGD so that an appropriate site for tube placement can be selected. Once "the spot" has been decided the patients abdomen is prepped with betadine and anesthetized with local anesthesia.

A scalpel is used to cut a small opening through which a trocar is inserted into the abdominal wall. The trocar is advanced until it can be seen coming into the gastric mucosa.

An insertion wire is then threaded through the trocar and snared. Once snared the wire is brought out through the patients mouth, the feeding tube is tied to the wire and pulled into place through the abdominal wall.

The tube is then secured in place by a small plastic crossbar.

This procedure takes about 10 - 15 minutes for completion. Feeding can be started 24 hours later.

Insertions wire or thread as it is inserted thru the trocar, snared and pulled through the patients mouth.

The feeding tube is tied to the insertion wire and pulled into place through the patients mouth.

Once in place the scope is reinserted to check placement and the crossbar is secured.

Inside mushroom	Crossbar in place

If replacement of the G-tube becomes necessary, the patient undergoes and EGD. The original tube is cut at the abdominal insertion site, snared, pulled through the abdominal wall and out the patients mouth. As the tube is pulled through the abdominal wall a replacement tube is inserted through the tract and balloon inflated to stabilize.

Snaring and Removal of original G-tube with replacement tube inserted and inflated.

This gastrostomy tube (foley catheter) migrated thru the pylorus. Note the large retention balloon. Patient was having signs and symptoms of bowel obstruction, the G-tube was replaced with a P.E.G. tube.

Nasogastric tubes used for feeding or decompression can cause gastric mucosal injury as noted in these photos.

From:  Endoscopy: " An Insiders Look" by Krista M. Stayton, RN.  Used with permission.