PEG Insertion Consent 🍽️
Consent guide for PEG (percutaneous endoscopic gastrostomy) insertion based on Oxford University Hospitals patient information. Procedure, preparation, risks, benefits, and alternatives.
🔍 Procedure
- PEG stands for percutaneous endoscopic gastrostomy: a feeding tube inserted through the skin into the stomach using a gastroscope.
- A gastroscopy (oesophago-gastro-duodenoscopy, OGD) is required to insert the PEG.
- A gastroscope is a flexible tube with a light and camera used to examine the oesophagus, stomach, and duodenum.
- Biopsies may be taken if needed; this is painless. Samples and photographs may be kept in the health record.
- The examination is carried out by a trained doctor or nurse endoscopist.
- PEG insertion is usually done in Endoscopy by a doctor and an Enteral Nutrition Clinical Nurse Specialist. Very occasionally it may be done in theatre.
💡 Indications
- Difficulty swallowing.
- Risk of aspiration (food going down the wrong way).
- Unable to get enough nourishment from the food eaten.
- Important: if the patient has reflux or regurgitation, a PEG will not improve that problem.
- The PEG can be removed in the future if it is no longer needed for nourishment; the dietitian advises on this.
🔄 Alternatives
- Nasogastric (NG) feeding tube through the nose into the stomach: more visible, less comfortable, more suitable for short-term use.
- For long-term tube feeding, a PEG is more comfortable, easier to manage at home, and more discreet under clothes.
- Radiologically Inserted Gastrostomy (RIG) in Interventional Radiology.
- Surgical placement in theatre involving a small operation.
- Discuss options with the medical team, dietitian, or Enteral Nutrition Clinical Nurse Specialist team.
📌 Preparation
- Do not eat, drink, or take anything for 6 hours before the appointment.
- A few sips of water are allowed up to 2 hours before the test. Eating will lead to cancellation.
- Diabetes (insulin or tablets): tell the team so timing can be arranged; seek advice on diabetes medicines at least 2 days before if not already advised.
- Anticoagulants or antiplatelets: seek advice at least 2 weeks before if not already advised.
- Stop iron tablets 1 week before.
- Stop stool bulking agents 4 days before.
- Continue routine medicines unless advised otherwise.
🧾 Procedure Walkthrough
- Expect to be in the department for most of a morning or afternoon; emergencies may take priority.
- On arrival: nursing assessment of fitness, heart rate, blood pressure, and blood glucose if diabetic; consent form checked or signed after further discussion.
- One dose of antibiotics is given through a cannula to protect from infection (routine for PEG insertion).
- Mouth guard between the teeth; dentures removed first if worn.
- Usually lie on the left side (or on the back if rolling is difficult). Finger probe monitors breathing and heart rate; breathing continues normally.
- Sedative and painkiller injection into a vein: drowsy and relaxed, not a general anaesthetic. Unlikely to remember the procedure afterwards.
- Suction tube in the mouth for saliva. Gastroscope passed through the mouth into the oesophagus, stomach, and duodenum. Air is blown into the stomach so it presses against the tummy wall; try not to burp the air up.
- Skin over the stomach cleaned with antiseptic. Local anaesthetic numbs the insertion site (may sting at first).
- A thin hollow needle is passed through the skin into the stomach. String is passed into the stomach, captured by the endoscopist, and pulled out via the mouth. The PEG is attached and pulled back into place.
- Pressure and prodding over the stomach may be felt; pain should not. An internal plastic disc stops the tube pulling out; an external disc stops it falling in. A small dressing may be used.
- PEG insertion usually takes 20 to 30 minutes.
🛏️ After the Procedure
- Recovery in the Endoscopy Unit; most people feel quite sleepy. Most patients stay in hospital after PEG insertion.
- The tube can feel a little uncomfortable at first, often due to wind; this generally settles after a few hours. Painkillers can be given if needed.
- In most cases water can be given through the tube first. Feeding through the tube can usually start 6 hours after insertion.
- If able to eat and drink, this can resume 6 hours after the PEG is placed.
- Over the following days: additional pain relief and IV fluids may be needed. The patient and family are shown how to use and care for the PEG (ward nurses, enteral feed company nurse, or dietitian).
🚨 After Discharge: When to Seek Help
- Contact the local Nutrition Support / Endoscopy team for: persistent sore throat, worsening chest or abdominal pain, excessive bleeding, or leakage of fluid around the tube insertion site.
⚠️ Risks & Complications
- A gastroscopy is simple and safe for most people. Serious problems are rare, but life-threatening complications are possible. Weigh benefits against risks of the examination, sedation, and PEG insertion.
- Perforation (tear) in the lining of the stomach or oesophagus, the liver, spleen, lining of the lung, or colon: approximately 1 in 200 nationally. Some cases are treated with antibiotics and IV fluids; surgery may be required to repair the hole.
- Bleeding at the PEG insertion site: nearly always stops on its own. Very rarely may result in hospital admission.
- Sedation-related problems with breathing, heart rate, and blood pressure: normally short-lived; monitored and treated quickly. Higher risk in older patients and those with significant health problems (e.g. significant breathing difficulties).
- Mechanical damage by the endoscope to teeth or bridgework: very rare.
- Heart attack or stroke related to sedation: very rare. More likely in elderly patients (heart attack) or those already at risk of stroke.
- Leaking from the stomach (peritonitis) after tube placement: about 1%.
- Unable to insert a PEG: around 4% (existing medical conditions or previous surgery). Referred back to the Nutrition Team to discuss alternatives, which may include a tube placed in interventional radiology.
- Pneumonia: 2%.
- Seeding from the mouth or throat in some cancers to the abdominal wall: nationally quoted as 1%.
- Minor complications: 15% of cases, mostly related to infection around the tube site.
- Risks increase with age and in those with heart, chest, or other medical conditions (e.g. diabetes), and in those who are overweight or smoke. Discuss individual risks.
✅ Benefits
- Allows feeding directly into the stomach to receive the food and fluid needed.
- For longer-term feeding, more comfortable and easier to manage at home than an NG tube.
- More discreet than an NG tube (can be tucked under clothes).
🧠 Special Considerations
- Formal written consent is required before the examination.
- If anything is unclear or needs further discussion, do not sign until after speaking with the endoscopist; the appointment can still go ahead.
- A copy of the signed consent form should be offered.
- People involved in care may include: Nutrition Support Nurses, Endoscopy Nurses, Dietitian, Medical staff/Endoscopists, and Ward Nurses.
- Interpreter support and alternative formats (easy read, large print, braille, audio, electronic, other languages) should be offered if needed.
- Patient support: PINNT (Patients on Intravenous and Nasogastric Nutrition Therapy) at www.pinnt.com.
Educational reference only. Medical disclaimer