Percutaneous Endoscopic Gastrostomy
Percutaneous Endoscopic Gastrostomy (PEG) is an endoscopic procedure that involves the insertion of a thin, flexible tube into the stomach of a patient. The PEG tube passes through the abdominal wall and is inserted deep into the stomach to make sure that accidental pulling out is avoided. Percutaneous Endoscopic Gastrostomy is done for patients who are unable to take food and liquids orally.
Such a condition arises when people suffer strokes as a result of head injury or because of occlusion in the arteries in the brain. A blockade can cause a hindrance in the flow of oxygenated blood to the sensitive neurons located in the brain. When these neurons are unable to respire and produce energy as a result, they are at a risk of being damaged.
If the occlusion persists for even a few minutes, a considerable portion of the brain can suffer, leading to a stroke. Even if this stroke is not dangerous in magnitude, the after effects it leaves behind are painful and crippling. Aside from numbness and stiffness in muscles, a condition called Dysphagia is also observed. Dysphagia is characterized as the inability of the muscles in the throat to contract and relax, making it impossible for a stroke patient to swallow.
The best way to overcome Dysphagia in the short term, as the patient starts recovery from the stroke, is the use of a PEG tube. At this stage, a patient’s body is very vulnerable and nimble. As the brain starts to make sense of motor and sensory functions again, it needs proper nutrition to recuperate. This nutrition is supplied via the PEG tube.
While the feeding tube used after stroke is a proven way to provide essential nutrients to the body in this early recovery stage, it also serves another crucial purpose. The PEG tube also helps avoid the onset of aspirational pneumonia that can result if food particles end up in the lungs instead of passing through the esophagus because of lack of control over the swallowing muscles.
Nutrition that passes through the PEG tube is called Enteral Nutrition, i.e. it directly makes use of the digestive system instead of passing through the mouth.
How is Percutaneous Endoscopic Gastrostomy Performed?
Percutaneous Endoscopic Gastrostomy is a relatively simple process. It is an alternative to complicated surgical insertions of feeding tubes after stroke called gastronomy insertion; and hence, does not require general anesthesia. A physician is trained for Percutaneous Endoscopic Gastrostomy, but may need the assistance of radiologists and surgeons.
The physician performs the Percutaneous Endoscopic Gastrostomy by applying local anesthesia to the throat. A thin wire that has a camera attached to it, called an endoscope, is inserted into the throat, all the way till the abdomen. This camera is connected to imaging machines that will indicate the presence and location of the PEG tube.
Once the camera is in place, the physician makes a small incision in the upper abdomen, over the stomach. The PEG tube is then pushed into the incision while the experts take a look at the images shown by the cameras on the screen. Once the right position is achieved, the feeding tube used after stroke is sutured in place.
Complications of PEG Tube
Percutaneous Endoscopic Gastrostomy is a commonly performed procedure, however, there are a number of complications of the PEG tube. It is important to remember that when the feeding tube after stroke is needed, the patient is already in a very critical condition. With a weak body and immune system, he is unable to have the same level of resistance in his body to accept new insertions.
It is for this reason that when the PEG tube is placed in the stomach via the abdominal wall, there is a risk of some complication such as:
• Cellulitis; a bacterial infection that affects the inner layers of the skin. It can develop around the incision of the PEG tube, causing pain and swelling. Skin affected by cellulitis turns red without sharp edges and takes a number of days to get back to normal with the use of antibiotics.
• Hemorrhage; a common complication of PEG tube. It refers profuse bleeding at the site of the incision. Since the patient is in the early stages of recovery, it is important for the bleeding to be controlled immediately.
• Gastric Ulcers; can form anywhere in the internal abdomen. They can either be found at the site of the PEG tube or at the opposite end of the stomach. These ulcers are painful and become a hindrance in the feeding process.
• Bowel Perforation; the longest part of the colon, called the Transverse Colon, passes through the abdomen in a downward shape and curves over the spleen. It is the only moving part of the colon, and hence, can cause complications of the PEG tube. Perforation in the bowel can be a result of percutaneous endoscopic gastrostomy.
• Peritonitis; such a perforation in the bowel leads to Peritonitis, which is the inflammation of the inner abdomen walls. A severe case of this condition causes heavy swelling that covers the abdominal organs as well.
• Liver Puncture; percutaneous endoscopic gastrostomy can cause another serious complication of PEG tube. This complication leads to a puncture in the left lobe of the liver. Such a puncture can make the liver weak and unable to perform its crucial function. If not controlled, it can turn into a serious liver collapse.
• Gastro colic fistula; another complication of PEG tube that can happen if feeding leads to diarrhea. In such a case, it is assumed that the feed enters the colon directly from the stomach.
• Buried Bumper Syndrome; characterized by the burying of the PEG tube into the gastric wall. It causes pain and extreme discomfort. Quick action has to be taken to get the tube back in place and prevent its migration in the future.
• Gastric separation; a condition in which the various cells and other components of the gastric environment separate instead of moving and acting together. This can be because of the insertion of a foreign object in the abdominal wall.