Percutaneous Endoscopic Gastrostomy (PEG)

WHAT IS PEG?

PEG is the process of inserting a feeding tube into the stomach through the anterior abdominal wall by entering through the mouth with a device called an endoscope, which has a lighted camera at the end, in cases where adequate nutrition cannot be taken orally. This method allows solid liquid foods and oral medications to reach the stomach directly.

WHAT IS PEG MADE FOR?

PEG is a nutritional method applied to improve the nutrition of patients who cannot be fed adequately orally for more than 2-3 weeks, whose food escapes into their lungs when fed or cannot swallow their food. Aim; to correct important nutritional deficiencies, to maintain the body’s fluid balance, to prevent weight loss, to increase the quality of life, to accelerate growth if there is developmental delay in children. With PEG, it may be possible for the patient to feed more safely and comfortably and to take sufficient calories. However, PEG does not cure the disease that causes the patient to be malnourished.

HOW IS PEG PROCESS DONE?

PEG procedure can be performed under sterile conditions in the endoscopy unit, when necessary, at the bedside, in the intensive care unit and in the operating room. The patient should be fasting at least 8 hours before the procedure. After the patient is anesthetized and his throat is anesthetized, the stomach is reached through the esophagus with an endoscope. In the meantime, the place where the catheter tip will be mouthed on the abdominal wall is anesthetized with local anesthesia, and a small incision is made regarding the skin and subcutaneous tissue. A guide wire is sent to the stomach through this incision, the PEG catheter is slid over the guide wire and inserted into the stomach. When the procedure is completed, there will be a tube for PEG to be used for feeding on the patient’s abdominal wall.

IS IT AN OBSTACLE TO NORMAL NUTRITION?

If it is not prohibited by the doctor, if there is no difficulty in swallowing or if the food does not go into the lungs (if there is no cough, suffocating sensations after feeding), normal oral nutrition can be continued with the approval of the following doctor.

IS PEG AN IRREVERSIBLE PROCESS? CAN IT BE REMOVED IF THE NEED IS AWAY?

It is not an irreversible process, it does not harm normal swallowing organs and mechanisms. It can be removed effortlessly when adequate nutrition can be provided by normal means.

HOW TO MAKE PEG CARE AND CLEAN?

first week: Dressing is done every day, the skin is cleaned and closed with a compress.

after the first week : Dressing is done every two or three days, the skin is cleaned with antiseptic and closed with a compress. Compresses used in cleaning should be sterile, the surface that will come into contact with the skin should not be touched.

WHEN CAN PATIENT BATH AFTER PEG INSTALLED?

It is okay to wash after the first week. After washing, it should be thoroughly dried and dressed (the skin is cleaned with an antiseptic solution and covered with a compress).

HOW TO FEED WITH PEG?

The patient can be fed using wide-mouth injectors or infusion pumps.

WHAT NUTRIENTS CAN BE GIVEN THROUGH PEG?

Other than ready-made nutritional solutions, all normal foods that have been ground or crushed into a fluid custard can be delivered through the PEG catheter. Care should be taken to keep the foods warm, hot foods may cause deformity in the tube, very cold foods may block the tube. Granular foods should not be given without crushing. Medicines can be given by diluting after crushing.

WHEN SHOULD PEG BE REPLACED?

PEG catheters do not have an expiration date, they can be used as long as they are functional. It should be replaced if the PEG catheter is punctured, if treatment-resistant skin infection develops, if the PEG catheter becomes embedded, if the PEG catheter is deformed enough to make it difficult to administer nutrients.

HOW IS A PEG CATHETER REMOVED?

Depending on the type of catheter, it is removed by endoscopy or by pulling from the abdominal wall.

WHAT ARE THE ALTERNATIVE METHODS?

Nutrition with a nasogastric (NG) tube inserted through the nose and inserted into the stomach: This method of feeding is a method that is applied to patients who are thought to be able to be fed orally after a while (6-8 weeks), but is not preferred because it can cause wounds in the nose, esophagus and even stomach when used for a long time. Displacement of the NG tube and undetected can cause life-threatening problems (such as the escape of nutrients into the lungs).

Surgical gastrostomy: Surgical gastrostomy is the procedure of placing a tube into the stomach by performing an operation by surgeons under general anesthesia. It may be necessary to apply PEG with endoscopic method, or for medical reasons (in patients who need reflux surgery in the same session).

Radiological gastrostomy:This procedure can be performed by an experienced radiologist in specialized centers accompanied by ultrasonography and/or fluoroscopy.

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