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Practice Clinical updates

Percutaneous endoscopic gastrostomy (PEG): a practical approach for long term management

BMJ 2019; 364 doi: (Published 22 January 2019) Cite this as: BMJ 2019;364:k5311
  1. Karima Farrag, GI fellow12,
  2. Yogesh M Shastri, head of department and specialist in gastroenterology3,
  3. Ulrike Beilenhoff, endoscopy nurse4,
  4. Ayşegül Aksan, chief dietician25,
  5. Jürgen Stein, head of department and specialist in gastroenterology12
  1. 1Department of Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt am Main, 60594 Frankfurt am Main, Germany
  2. 2Interdisciplinary Crohn Colitis Centre Rhein-Main, 60594 Frankfurt am Main, Germany
  3. 3NMC Specialty Hospital, Abu Dhabi 6222, United Arab Emirates
  4. 4Scientific Secretariat, European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA), 89075 Ulm, Germany
  5. 5Faculty of Health Sciences, Hacettepe University, 06532 Ankara, Turkey
  1. Correspondence to: J Stein j.stein{at}

What you need to know

  • Percutaneous endoscopic gastrostomy (PEG) tube feeding is a temporary or permanent treatment in patients unable to eat orally and requiring long term nutritional support (over 30 days)

  • Advise patients to loosen the tube once or twice a week and flush it with warm water before and after feeds to prevent tube clogging and peristomal complications

  • Encourage patients to follow the recommended nutrition plan and consult a nutritionist for modifications needed in case of feeding or gastrointestinal problems

  • Refer the patient for specialist management if the tube is dislodged or clogged or there are signs of peristomal leakage, infection, or bleeding

  • Replacement of the tube is required if it is clogged and hinders feeding or medication, broken, or leaking

Non-specialists may be involved in care of patients with gastrostomy tubes, in a nursing facility, hospital, or at a patient’s home. In this article, we describe common complications of percutaneous endoscopic gastrostomy to help non-specialists prevent and recognise severe or potentially life-threatening situations and to refer them on for specialist management.

What is percutaneous endoscopic gastrostomy?

Percutaneous endoscopic gastrostomy (PEG) is performed to deliver enteral nutrition directly to the gastrointestinal tract, bypassing the oral cavity.1 Along with alternatives, such as nasal tubes or jejunal feeding, it plays an important role in maintaining nutrition in patients unable to eat orally. Such patients include those with dysphagia, intestinal failure, head or neck cancer, or as treatment in patients with gastrointestinal disease.123 PEG is first line treatment for patients with a functional gastrointestinal tract but inadequate oral nutrient intake who require long term nutritional support (>30 days).45

A gastrostomy tube is inserted percutaneously (through the skin) into the stomach via a small incision performed under local anaesthetic and positioned using an endoscope through the mouth.6 The entry point is known as the PEG …

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