Percutaneous gastrostomy is an endoscopic procedure in patients who can not receive food by mouth during which a special feeding tube is placed from the outer abdominal wall to the inside of the stomach. This allows us not only to administer special nutritional solutions through the tube directly into the stomach, but also drugs by bypassing the oral cavity and esophagus.
It’s recommended for people who are unable to feed orally due to difficulty in swallowing (dementia, Parkinson’s, stroke, tumors in the pharynx or esophagus, etc.).
PEG (Percutaneous Endoscopic Gastrectomy) is the simplest, safest, cheapest and painless gastrostomy placement and it can be for temporary or permanent use.
Before the procedure
It is forbidden to take any food at least 12 hours before the procedure and to drink fluids on the day of the examination.
In order to perform the examination, the patient must stop any anticoagulant treatment (Warfarin, Xarelto, Eliquis, heparin, clopidogrel – Plavix, etc.) that he/she receives and replace it with subcutaneous heparin injections. This will always be done in consultation with the treating cardiologist.
Do not forget to mention any allergies to medications.
During the procedure
The procedure is always preceded by gastroscopy in order to locate the point of delivery of the gastrostomy in the stomach.
The doctor will then make an incision no larger than 2 cm in the anterior wall of the abdomen through which the gastrostomy tube will pass, and it will be attached to the abdominal wall. This tube can now be used to feed the patient but also to administer medication.
The procedure lasts 20-45 minutes.
After the procedure
The stomach and abdominal wall usually heal in a few days.
As a rule, the presence of the gastrostomy tube is very well tolerated by patients. If the gastrostomy tube is accidentally removed by the patient it can be repositioned (easy, fast and painless)
For the first 6 to 24 hours the patient receives intravenous fluids, as for safety reasons we do not administer anything through the gastrostomy. Then, with the supervision of a clinical dietitian, the patient begins to be fed with special nutritional solutions.
If the patient’s ability to swallow recovers, the gastrostomy can be permanently removed with a very simple procedure that takes a few minutes.
If the patient is cared for at home, he/she can stay in the hospital for 24 hours so that the nursing staff can train the person who will take care of the gastrostomy. If the patient comes from other institutions with experience in gastrostomy care he/she can return immediately after the procedure.
Are there any risks from the procedure?
Complications after a gastrostomy are very rare if done by an experienced endoscopist.
Complications include:
• Pain at the incision site in the first hours or days after the procedure.
• Small leakage of fluid or food from the incision site.
• Displacement, malfunction, blockage or contamination of the tube.
• Infection at the skin incision site.
Even rarer complications include bleeding, peritonitis and damage to the bowel or nearby organs.
Kadis Savvas MD FRCP (UK)
Gastroenterologist / Hepatologist
Dr Kadis, private Gastroenterologist – Hepatologist has got extensive experience in all aspects of Gastroenterology and Hepatology including gastroesophageal reflux, peptic ulcer disease and haemorrhage, coeliac disease, small bowel disease and capsule endoscopy, inflammatory bowel disease (ulcerative colitis and Crohn’s disease), diverticular disease, pancreatic disease, cirrhosis etc.
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