Hi

There have been several questions related to issues with PEG feeding. So, not knowing the answers I decided to educate myself! I hope you too will find the following information and links useful:

PEG (percutaneous endoscopic gastrostomy) is the shortened term used to refer to the tube, made of flexible silicone, that allows liquid feeds to be put directly into the stomach. A standard gastroscope, the type used to examine the stomach, is used to place a tube through the wall of the stomach and abdomen. Hence the technique is called percutaneous endoscopic gastrostomy (PEG). In general, PEGs are placed to provide nutrition for patients who cannot eat, and who have a normally functioning gastrointestinal tract as after treatment of head, neck or esophageal cancers. Percutaneous endoscopic gastrostomy tube feeding is a safe and effective method of providing long term enteral nutrition to oropharyngeal cancer patients and offers advantages over nasogastric (NG) feeding.

Compared with most kinds of surgery, it is a safe, uncomplicated and almost routine procedure. Most complications are minor and occur in approximately 5-10% of cases. Usually, these consist of easily treatable and uncomplicated wound infections, bleeding or abdominal pain. Major complications are rare, occurring in only 1-2% of cases. The overall mortality rate of PEG procedures is 0.3-1%. Infection (like peritonitis) is a rare, though a potentially serious complication. Even rarer complications are severe bleeding and intestinal obstruction. PEGs can become clogged. Accidental removal of the tube by the patient is another common complication.

In one unit's experience of 441 patients who underwent PEG, there were 144 incidents of post-PEG complications, including gastric ulcer. They concluded that use of a PEG tube with a long protruding tip was associated with a significantly higher frequency of post-PEG gastric ulcer due to contact injury to the gastric mucosa caused by the tip of the tube. So choosing the appropriate PEG tube may be crucial in preventing gastric ulcer after PEG placement.
View: the PEG Tube.

James Collier BSc (Hons) - Consultant in Nutrition and Moderator of Dietetics.co.uk has written Enteral Feeding - An Overview

National University of Singapore's Patient Education Materials Guidelines:

• What is a PEG?
• Feeding through the PEG tube
  
• Caring for the PEG

Other useful informative sites:

• PEG -What is it a UAMS pdf
  
• PEG feeding -Making the decision a MNDA pdf
  
• Home Feeding Guide Excellent information for anyone on a feeding tube!
• Tube Feeding - Discharge Instructions a Northwestern Memorial Hospital pdf
  
• Information about Feeding Tubes a ALS-Florida pdf
  
• About Feeding Tubes good info from the Oreghon ALS chapter
  
• Feeding Tubes - Dental Care You still need to brush your teeth!
  
• TYPES OF TUBES and FEEDING PUMPS Information on the different types of tubes and pumps, advantages and disadvantages!

(Reader's comments and tips on tube feeding are welcomed. Just reply below.)

Best wishes
Vinod

This message has been edited. Last edited by: Dr Vinod K Joshi,

Thank you so much that information was very helful for me.ALways Vicki

ditto, thanks for the links, I know its not 'your' specialism, but it (PEG problem) has the potential to negate all the surgeon's hard work. My husband John is still in hospital was recovering well from a second operation to cut out oral cancer but is now back in hospital as a result of PEG-induced peritonitis and septicaemia. Here's a site that goes some way to informing patients and carers about getting nutrition - not as good as our-doc, but still developing (don't you go across to them Krishan!!)
I am staying at hospital with John at present, so can't get to the board very often, hope to get back to 'normal (?!) soon

Jenbee realy sorry to hear of the complications to John right now. It must be very difficult for you both to have this added burden on top of everything else.

Take special care to be kind to yourself too.

ARE YOURS FALSE?
I have fouind a great glue for my false teeth it is called SMILE Boots own brand, if your watching the pennies it cheaper and more contents(50ml) than the well known one and you use less.

commision to DB's false teeth benefit

Paul!

PEGS! not toothie pegs!

I hadf a RIG rather than a PEG. (they come out easier)Solved my blockages with a little cola or bi carb!

For more information on "Drip or tube feeding" and to find out what a RIG is, click here.

Dam I am so embaressed about myn posting pegs!
I must have been half asleep when I read it and not many on here will have any idea what I meant OOPS

Paul

I don't understand why anyone with tonsil cancer would be fitted with a PEG. I was told in hospital that the reason I was fitted with a RIG was that a PEG can spread the cancer when inserted down the throat?

What is a RIG? And crap - I have aPEG - too late now lol

Love Chloex

This should explain it, it's from the Cancer Backup site:

Radiologically inserted gastrostomy tube (RIG)
These tubes are gastrostomy tubes which are put directly into the stomach under X-ray guidance. This is done for people who can't have an endoscopy, perhaps because because of a tumour in the oesophagus.

Dear Ray, I'm wondering if your informant was confusing a PEG tube, which goes through the abdomen into the stomach, with a Naso-gastric tube which goes through the nose into the stomach? A bit worrying if that message is being passed on by a member of your medical team. Fran

Hi Fran

I too was rather confused by this statement by the hospital. How this all came about was when I asked why I had a RIG instead of a PEG because all the PEGs I had seen had an in-line clamp to aid the insertion of flushing, feeding and medication. My RIG, however, lacked this facility and it was only due to the Homeward nurse supplying me with an extension tube that had this clamp, that I managed to cope with the day to day management of my tube. The "nutrition nurse" (at RUH Bath) who dealt with my RIG seemed to either lack any overall knowledge of the RIG, or was more interested in simply getting the job done with the minimum of patient contact and getting off home. After further dealings with her I believe it to be the latter. Needless to say, after further problems with this hospital, my GP has removed me from their "care". I have to thank them for eventually diagnosing my condition but their patient care and level of service stink. However, I have nothing but praise for the care and attention, sometimes above the call of duty, that I received from the Bristol Haematology and Oncology Centre where I was treated.
Ironically, although I was told that a PEG insertion would necessitate a tube down my throat which could spread the cancer, I did had to have to have a naso-gastric tube inserted so they could inflate my stomach prior to cutting me open.

Hi Ray,glad you got things sorted, after a poor initial experience. The Homeward nurses are good arnt they? Fran