Endoscopic Gastrostomy (Peg) Tube Insertion Kenya

What is a percutaneous endoscopic gastrostomy (PEG) tube?

This is a surgical procedure performed to insert a tube into the stomach. It is typically recommended for patients experiencing difficulties with swallowing, such as those with swallowing disorders, stroke, cancer affecting the mouth or esophagus, and various esophageal diseases. It’s placed using a lighted flexible scope called an endoscope that allows the endoscopist to see inside your stomach as the procedure is done. The tube stays in the stomach for months or years so you can receive fluids, medicines, and nutrition when you are unable to eat with the mouth. It is important to let your healthcare provider know if the tube comes out because the opening will close quickly.

Indications of a PEG Tube

A PEG tube may be inserted for children or adults who are unable to eat and drink enough to meet their daily nutritional needs. Most common conditions in which a PEG tube may be suggested include:

Birth defects
Problems swallowing
Stroke
Cancer of the mouth or esophagus
Diseases of the esophagus
Patients in a coma or kidney failure

Some conditions like minor stroke require temporary insertion of a PEG tube until recovery. Permanent PEG tubes require to be replaced after one year.

Risks of PEG tube placement?

They may include the following but not limited to these only:

Reactions to the anesthesia
Pain around the stomach
Leakage of stomach contents around the tube
Infection of the tube site
Infection that spreads inside the belly
Aspiration – flowing of stomach contents to the lungs
Bleeding from the incision area
Bleeding or infection from damage to other organs inside the belly
Blockage or dislodging of the tube

How to Prepare for the Procedure

Fast before the endoscopy. You’ll typically need to stop eating solid food for eight hours and stop drinking liquids for five hours before your procedure. This is to ensure your stomach is empty for the procedure.
Stop taking certain medications. Tell your provider about any medications you maybe taking, allergies or allergies to medication. You’ll need to stop taking certain blood-thinning medications in the days before your procedure. Blood thinners may increase your risk of bleeding hence you will be asked to stop taking them days before your surgery. If you have ongoing conditions, such as diabetes, heart disease or high blood pressure, your provider will give you specific instructions regarding your medications.
If you smoke or take alcohol, you may be asked to stop well before surgery.

Plan ahead for your recovery

Plan ahead for your recovery while the sedative wears off. Make sure you are accompanied by a family member/friend.

Procedure Day

PEG tube placement is usually done under local anesthesia and sedation in about 20 mins. It involves:

The skin over your belly is cleaned and a numbing medicine is injected.
The endoscope is passed through your mouth into your stomach.
A small surgical cut is made through your skin and into your stomach.
The PEG tube is inserted through the opening while the healthcare provider watches through the endoscope.
The tube is held in place inside your stomach with the help of a special balloon or a cap.
A small dressing is placed at the new opening.

What happens after PEG Tube placement?

You may feel pain at the incision site, you may also experience cramping or gas pain. Follow your discharge management instructions for pain control.
The dressing over the incision area must be kept dry and can be removed after about 1 or 2 days as instructed. Ask your doctor when you can start showering and bathing.
The incision area takes about 5 days to heal. You will be taught how to clean the area daily with soap and water. After cleaning, dry the area using a small gauze pad to cover it. Don't let the gauze or the tube bumper become too tight against your belly. They should lose.
You should be able to gradually return to normal activities, depending on your overall condition. Your doctor will advise you on any activity restrictions.
Use of the PEG tube for feeding begins gradually with clear fluids and progresses to special formula feedings.
You will be told to make sure you are always upright when feeding. You may still be able to eat by mouth. Talk this over with your healthcare team.