percutaneous endoscopic gastrostomy

Last edited 05/2021 and last reviewed 10/2023

Percutaneous endoscopic gastrostomy (PEG) describes the endoscopic formation of a feeding gastrostomy. It negates the need for a laparotomy and general anaesthesia.

There has been a 20% increase year-on-year over the last decade in patients registered to receive Home Enteral Tube Feeding (HETF) in the UK and these patients are maintained on this regime for longer [1]. At the end of 2002 there were 19,500 adult patients in the UK on HETF, an average of about one patient per general practice

Technique:

• the patient is fasted for 6 hours and sedated intravenously. The stomach is then distended with air from an inserted endoscope. Using the light source of the endoscope for guidance, the abdominal wall is then punctured externally and an IV cannula passed through to the stomach. Externally, a long piece of silk suture is then passed through the cannula, is grasped by the snare of the endoscope, and both are removed via the mouth
• the free end of suture coming out of the patient's mouth is then tied to a specialised tapered catheter. After lubrication, the catheter is drawn by pulling on the abdominal wall free end of silk down into the stomach and through to the anterior abdominal wall.

Reference:

• (1) Glencorse C, Meadows N, Holden C: Trends in artificial nutrition support in the UK between 1996-2002. A report by the British Artificial Nutrition Survey (BANS). A committee of the British Association for Parenteral and Enteral Nutrition. British Association for Parenteral and Enteral Nutrition 2003.