Enteral Tube Program

Percutaneous Endoscopic Gastrostomy (PEG) Tube

What is a gastrostomy tube (g-tube)?

A gastrostomy tube (often called a g-tube) is a tube that is placed into the stomach through a hole called a “stoma.” A g-tube may be used to give your child formula and/or fluids because your child is not able to take enough nutrition by mouth. The g-tube may also be used to give medicines. There are different types of g-tubes, which may be placed by general surgeons, radiologists, or gastroenterologists (GI doctors).

What is a Percutaneous Endoscopic Gastrostomy (PEG) tube?

A PEG tube is a type of g-tube that is placed through the stomach wall with the help of an endoscope. An endoscope is a long, thin, bendable camera which lets a GI doctor see the inside of your child’s stomach. The PEG tube is a long tube with a soft, nickel-sized disk at one end. This disk is called a “bumper” and it holds the PEG tube in place in the stomach after placement (Figure 1).

Your GI doctor will talk about this procedure with you and discuss whether a PEG tube is the right type of g-tube for your child.

Figure 1

What should I know about the placement of a PEG tube?

For the PEG placement, your child will be put to sleep by an anesthesiologist. Placement of a PEG tube usually takes 15-20 minutes. The whole procedure may take up to 1 ½ hours to give your child time to get comfortable and fall asleep. The placement is performed in an operating room or in the gastroenterology procedure unit (GPU). At Children’s Hospital Boston, all PEG tubes are placed by both a GI doctor and general surgeon working together.

After your child is asleep, a GI doctor will put the endoscope down his/her esophagus (the part of the body that leads from the mouth to the stomach) and into the stomach (Figure 1). A general surgeon will work with the GI doctor to place the PEG tube in the stomach. The PEG tube will be set with the bumper resting against the inside of the stomach wall.

Are there any risks with the PEG procedure?

Major risks are rare but include:

more bleeding than is expected
a serious infection
damage to the large intestine, esophagus, or other nearby organs

Minor risks include:

skin infection
leaking of stomach contents into the abdomen
extra air inside the abdomen
pain at the PEG tube site

Your GI doctor will talk about other possible risks with you before the procedure. All children are given antibiotics during the procedure to help lower the risk of infection at the PEG site. Please talk with your GI doctor if your child has any allergies to antibiotics or if you have any questions about the risks of the PEG procedure.

Is there pain after the PEG procedure?

Yes. Your child may feel some pain at the PEG tube site after the procedure. This is normal. Your child will be watched closely after the surgery for pain, and medicine will be given as needed. Your child should feel better within a few days after the procedure. If your child seems to have any long-term pain from the PEG tube site, please tell your child’s GI doctor.

What are other options to having a PEG placed?

One other option is to use a nasogastric (NG) feeding tube. An NG feeding tube is a small tube placed through a child’s nose and into their stomach. It may be used for a short time to give nutrition and/or medicine to children. Some risks with long-term use of NG tubes include: soreness in the nose or throat, accidental removal requiring replacement, skin irritation on the face from tape, and infection.

Other types of g-tubes that are placed by a general surgeon or radiologist may also be considered. If you are interested in another type of g-tube, please talk with your child’s GI doctor before the PEG tube is placed.

How long will a PEG tube stay in my child?

How long your child has a PEG tube depends on why the tube was placed. Eventually, the PEG tube may be removed if your child no longer needs to receive nutrition, fluids or medicine through it. At that time, your child’s GI doctor will talk about the best way to remove the PEG tube.

Will the PEG tube fall out once it is placed?

It is very hard to remove a PEG tube by accident and rare for it to fall out. The bumper inside the stomach wall helps keep the PEG tube in place. Also, the bar on the outside of the stomach helps secure the PEG tube against your child’s skin.

If the PEG tube comes out after you leave the hospital, DO NOT try to replace it on your own. The tube must be replaced by a trained doctor or nurse. Call your GI doctor, tape gauze over the stoma, and bring your child to the Children’s Hospital Emergency Department right away.

If you cannot get to Children’s Hospital Boston within 2 hours, you may have to take your child to a closer hospital first. Please have the local doctor call the GI doctor on-call at Children’s to discuss the best plan when you arrive.

Your child’s stoma may close up if the PEG tube is out for more than a few hours.

When can we exchange the PEG tube for a skin level g-tube?

Most PEG tubes stay in place for at least 3-6 months and then are changed to a smaller, skin level g-tube, such as a MIC-KEY™ g-tube. This skin level g-tube is sometimes called a “button.” There are two ways to exchange the PEG tube for a skin level g-tube. Your child’s GI doctor will talk about these methods with you. For more information see Percutaneous Endoscopic Gastrostomy (PEG) Exchange.

If my child is no longer using the PEG, how is a PEG tube removed?

There are two ways to permanently remove a PEG tube. For more information, see Planned Removal of a Gastrostomy Tube (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 PEG 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.