Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement

A percutaneous endoscopic gastrostomy (PEG) tube is a feeding tube that is surgically placed through the abdomen into the stomach. (It is also often referred to as a G-tube). During this procedure, a gastroenterologist uses a lighted flexible scope called an endoscope. The endoscope the doctor to see inside the stomach as the procedure is being done. The PEG tube stays in the patient’s stomach for months or years and allows the child to receive fluids, medicines and nutrition when they can’t take in enough nutrition by mouth.

A PEG tube may be a good choice for children, adolescents and young adults who can’t eat and drink enough to meet their daily nutrition needs. A PEG tube may also help prevent a dangerous condition called aspiration. Aspiration can occur if someone has trouble swallowing normal, and then breathes food or liquids into the lungs.

Some common conditions in which a PEG tube may be recommended include:

  • Problems swallowing
  • Aspiration
  • Anatomical barriers
  • Birth defects
  • Diseases of the esophagus.

A PEG tube may be placed if a child has a long-term condition that will not allow them to swallow. To have this procedure, patients must be able to digest food normally once the food reaches the stomach.

Understanding the PEG Tube Placement Procedure

PEG tube placement is a safe procedure, but all surgeries carry some risks. Parents (legal guardians) will need to sign a consent form that explains the risks and benefits of the surgery and should discuss these risks and benefits with your child’s surgeon or gastroenterologist.

Some potential risks of PEG tube insertion include:

  • Reactions to the anesthesia
  • Pain at the incision site
  • Leakage of stomach contents around the tube
  • Infection of the tube site
  • Infection that spreads inside the abdomen
  • Bleeding from the incision area
  • Bleeding or infection from damage to other organs inside the abdomen
  • Blockage or dislodgement of the tube.

Although very rare, perforation into other organs and esophageal tears are possible.

There may be other risks, depending on the child’s specific medical condition. Be sure to discuss any concerns with the child’s surgeon before the procedure.

What to Expect Before the Procedure

In the days before the surgery, be sure to tell your child’s surgeon or gastroenterologist about any prescription medications, over-the-counter medications or herbal supplements your child may take. In some cases you may be asked to stop giving your child certain medications prior to the procedure. Also be sure to:

  • Tell the doctor if your child or someone in your family has any history of reaction to anesthesia.
  • Follow all instructions given on when your child cannot eat or drink prior to the procedure.
  • Ask the doctor performing the procedure if your child should take their regular medications with a small sip of water.
  • Dress your child in loose, comfortable clothing on the day of surgery.
  • Try to find other arrangements for other children the day of the procedure. After the procedure, parents will be provided with a lot of information. It is important for parents to be able to focus on their child and learn as much as possible from the hospital staff before heading home.

Learn more about what to expect in the days leading up to surgery at CHOC.

What to Expect the Day of the Procedure

After being admitted to CHOC, your child will be provided a private room in the preop area in our Tidwell Procedure Center. There, your child will have an intravenous line (IV) started in his or her hand or arm to receive fluids and medications. You will meet with both the anesthesiologist and the endoscopist before the procedure begins. PEG tube placement is usually done under monitored anesthesia. Your child may be given pain medication and medication to make them sleepy through the IV. Antibiotics may also be given through the IV.

Because an endoscope is inserted down the child’s throat, a numbing medicine may be sprayed to prevent gagging and a mouth guard may also be inserted. The actual procedure takes about 20 minutes. This is what usually occurs during the procedure:

  1. The abdomen is cleaned and a numbing medication (local anesthetic) is injected.
  2. The endoscope is passed through the child’s mouth into the stomach.
  3. A small surgical cut is made through the skin and carried down into the stomach.
  4. The PEG tube is inserted through the opening while the surgeon or gastroenterologist watches through the endoscope.
  5. The tube is held in place inside the stomach with the help of a special bolster.
  6. A small dressing is placed at the new opening.

Learn more about what to expect the day of surgery at CHOC.

What to Expect After the Procedure

After the procedure, your child is taken to the recovery area to recover from the anesthesia. Some patients go home the same day while others may stay overnight at the hospital for observation.

After surgery most patients:

  • Experience pain at the incision, cramping or gas pain. You will be provided information on pain control prior to going home.
  • Your child can usually have the dressing over the incision area removed after one or two days.
  • The incision area will heal in about five days. Patients and their caregiver will be taught how to clean the area daily with soap and water. After cleaning, the area should be dried and covered with a small gauze pad.
  • Your child should be able to gradually return to normal activities, depending on their overall condition. You will be provided with activity restrictions before going home.
  • Begin using the PEG tube for feeding gradually with clear fluids and progress to special formula feedings.

Before heading home from the hospital, be sure to ask your child’s health care team the following:

  • When your child can start showering and bathing
  • How to care for the skin around the tube
  • What symptoms to look for that could indicate an infection
  • How to empty your child’s stomach
  • What to do if the tube gets blocked
  • What formula to use and how to feed your child.

It is important to contact the child’s doctor about any of the following:

  • Increasing pain or pain that is not relieved by medication
  • Any drainage, bleeding, redness or swelling around the tube
  • Fever
  • Vomiting, cramping, nausea or diarrhea
  • Aspiration (breathing food bits into the airway)
  • If the tube comes out or there is a blockage in the tube.

Enteral Feeding Support at CHOC

There are bound to be a lot of unanswered questions from caregivers to siblings, friends, extended family and others who interact with your child’s enteral nutrition (a feeding tube). At CHOC we are here to help patients and their families with any nutrition, equipment and line-care issues. We even provide guidance for families who wish to move their child to a blenderized diet made with real food and not formula.

Learn more about enteral feeding support at CHOC.

Learn More about G-tube Home Care

There is a lot to know about taking care of your child’s G-tube at home. This handy guide provides families with great reminders and information on caring for a child using a G-tube for nutrition.

Download our G-tube Home Care Guide in English.
Download our G-tube Home Care Guide in Spanish.