GASTROSTOMY, PERCUTANEOUS ENDOSCOPIC (P.E.G. Procedure)

General Information

DEFINITION--Surgical technique for placing a feeding tube without having to perform an open laparotomy (operation on the abdomen). This procedure is less costly and time consuming than a surgical gastrostomy (see in Surgery section).

BODY PARTS INVOLVED--Stomach; skin; structures of the abdominal wall.

REASONS FOR SURGERY--To provide nutrition for those who cannot swallow.

SURGICAL RISK INCREASES WITH

• Stress; obesity; poor nutrition; smoking.
• Excess alcohol consumption.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES--General surgeon, otolaryngologist or gastroenterologist.

WHERE PERFORMED--Hospital or outpatient surgical facility.

DIAGNOSTIC TESTS--Before surgery: Blood and urine studies; x-rays of gastrointestinal tract.

ANESTHESIA--Local anesthesia (usually lidocaine spray).

DESCRIPTION OF OPERATION

• The endoscopist anesthetizes the throat with lidocaine or other local anesthesia.
• The endoscopist passes the endoscope to the appropriate point in the stomach.
• The surgeon depresses the abdomen from the outside so the endoscopist can visualize the movement.
• The surgeon makes a small incision into the skin and pushes an intravenous cannula through the skin into the stomach. At the same time, the surgeon uses silk sutures pre-stiffened with a liquid protecting dressing wipe.
• When the endoscopist sees the suture, it is grasped with forceps.
• A gastric catheter and the stomach suture are tied securely.
• The surgeon pulls the suture and catheter through the abdominal incision, places a bolster over it and sutures the bolster to the abdominal wall.

POSSIBLE COMPLICATIONS

• Abscess formation; wound infection.
• Inadvertent tube dislodgment.
• Catheter malfunction.

AVERAGE HOSPITAL STAY--0 to 1 day for procedure. Total time varies according to underlying disorder.

PROBABLE OUTCOME--Satisfactory alternate method of feeding.

Postoperative Care

† Move and elevate legs often while resting in to bed to decrease the likelihood of deep--vein blood clots.

† You may use non--

prescription drugs, such as acetaminophen, for minor pain.

• Avoid aspirin.

ACTIVITY---Resume normal activity as soon as possible to promote healing.

DIET

• Your doctor will prescribe a diet.
• Vitamin and mineral supplements (sometimes).

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increases in the surgical area.

• You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• You experience nausea, vomiting, constipation or abdominal swelling.