Enteral Tube Program

Percutaneous Endoscopic Gastrostomy (PEG) Exchange

What is a PEG tube exchange?

A PEG tube exchange is a procedure that removes a PEG tube and replaces it with another type of gastrostomy tube (g-tube), such as a MIC-KEY™, MIC-G™, or other g-tube.

The exchange is done so your child may receive nutrition and medicines through a smaller g-tube. Compared to a PEG tube, these g-tubes are easier to change (at home or in clinic) as your child grows.

When is the exchange performed?

Your GI doctor will talk to you about scheduling a PEG tube exchange around 3-6 months after your child’s PEG tube is placed.

How and where is the exchange done?

There are two ways to exchange the tube. Both procedures are performed by a GI doctor. Your child’s GI doctor will talk about both options, including the risks and benefits of each, with you and your child.

An endoscopic exchange is performed either in the Gastroenterology Procedure Unit (GPU) or an operating room. Your child will need to be put asleep by an anesthesiologist for this procedure. Once your child is asleep, the GI doctor will use an endoscope to remove the PEG tube from the inside of the stomach. An endoscope is a small thin tube with a light that helps a doctor to see the inside of your child’s stomach. Once the PEG tube is removed, a new g-tube will be placed in the stoma. The GI doctor will then use the endoscope to check the position of the new g-tube in the stomach.
A percutaneous exchange is performed in our Gastroenterology Procedure Unit (GPU). Your child does not need to be put asleep by an anesthesiologist for this procedure.
Your child will be laid on his/her back and the GI doctor will pull the PEG tube out by hand through the stoma. Your child will feel a little bit of pain for a short period of time during this procedure, but this will go away. Once the PEG tube is removed, the new g-tube will be placed. In rare cases there may be injury to the stoma.
After the new g-tube is placed, your child will need a special x-ray to make sure the new g-tube is in the correct place in the stomach before your child goes home. This x-ray will happen either in the GPU or in the Radiology department.

What happens after the procedure?

After the procedure is finished, the GI doctor will let you know how your child is doing. When ready, a nurse will bring you to be with your child and go over any questions you have about the new g-tube.
A nurse will go over all discharge instructions with you and give you information sheets about the use and care of your child’s new g-tube.
Your child is usually able to go home once they are fully awake after the endoscopic exchange.
Your child is usually able to go home once the x-ray is completed after a percutaneous exchange.
Your child will need a responsible adult with them when they leave the hospital.

Going home from the hospital with a MIC-KEY™ g-tube:

Your child will be sent home from the hospital when:

You have reviewed the information sheet about your new g-tube and feel comfortable with its care:
Home Care Instructions for Use and Care of the MIC-KEY™ Skin Level Gastrostomy Tube
Home Care Instructions for Use and Care of the MIC-G™ Gastrostomy Tube

Follow-Up

Your child’s g-tube will need to be changed routinely, usually every 3-6 months. The first change will likely take place in the GI clinic with you and one of the GI nurses.

Please call the GI clinic at (617) 355-6058 to schedule a 3 month check-up visit with your child’s GI doctor. Please bring a replacement g-tube with you to this visit.
A prescription for the new g-tube and supplies will be sent to your home care company. Please call your home care company to make sure that they have received these new prescriptions. If they have not received these prescriptions, please contact the GI office as soon as possible.

Call the GI doctor or nurse if:

Your child continues to have pain after the exchange that won’t go away.
The g-tube falls out and you are not able to put it back into the stoma.
The g-tube is leaking.
Your child shows signs of having trouble with feedings such as: coughing, choking, throwing up, diarrhea, stomach pain, or constipation.
You notice signs of infection at the g-tube site such as: redness, rash, fluid draining, swelling, soreness, strange smell, or fever.
You have any questions about the exchange or your child’s new g-tube.

Who can I call if I have questions?

Please call the GI office (617) 355-6058 if you have questions or concerns. Our GI nurses can help you with all types of g-tube questions:

Monday–Friday, 8:00am–4:30pm, a nurse in the GI clinic will be available to help you.
Weekdays after 4:30pm, Weekends, and Holidays, you can use the same number to reach a GI doctor on-call for urgent questions or emergencies.

If your child is followed by General Surgery:

Call the General Surgery outpatient nurses at (617) 355-7716 or (617) 355-7704.