Percutaneous Endoscopic Gastrostomy (PEG)
Patients with difficulties with swallowing after stroke or dementia (neurogenic dysphagia) have to be fed by nasogastric tubes in order to get adequate nutrition. If they require nasogastric feeding for longer than 6 weeks, gastrostomies can be considered as this method is more comfortable for the patients and easier for the relatives to take care. Gastrostomies (opening into the stomach) may be created surgically, endoscopically, radiologically or laparoscopically. The endoscopic method of gastrostomy creation is called Percutaneous Endoscopic Gastrostomy (PEG). PEG is a long-term gastrostomy device inserted endoscopically (with gastroscope) under local anesthesia (lignocaine) and intravenous sedation (usually midazolam).
The following are advantages of PEG over nasogastric tubes:
- PEG tubes are not easily extruded.
- PEG tubes are of larger calibre thus are not so easily blocked.
- No nasopharyngeal (throat) discomfort for the patients.
- Cosmetically more acceptable for patients, especially those who are ambulant.
However, the procedure is minimally invasive and careful patients selection is needed. It is not suitable for all patients with swallowing difficulty. The procedure also carries some complications. The serious complications such as peritonitis and haemorrhage, are not frequent but carries significant morbidity and mortality if they occur.
For PEG insertion, two doctors are present for the procedure. One performs the gastroscopy and the other will make the opening into the stomach. The aim is to deliver a feeding tube from the stomach into the abdominal wall. The opening on the abdominal wall is called “stoma”.
The feeding tube will allow caregiver to instill milk and medication directly into patients’ stomach. The feeding tube can usually last for more than 6 months. New tube can be easily replaced once a track has been formed by the original procedure. Gastroscopy is not needed during tube replacement. The most common long term complication is skin infection. Carers are taught on the need for regular and diligent skin care around the stoma site.