What is a gastrostomy tube, PEG/PIG?
A gastrostomy is a small feeding tube connecting
your stomach cavity directly to the overlying skin.
It enables you to receive food, fluids and medicine
directly into your stomach when it is difficult or
unsafe to use the normal route via the mouth. It can
be put in via two methods: PEG or PIG.
PEG stands for Percutaneous Endoscopic
Gastrostomy – inserted via a telescope down the
PIG stands for per oral radiologically inserted
Why would I need one?
If, due to weakness of the muscles of the mouth and
throat, you have difficulty swallowing food and/or
drink/medicines, or if you are likely to have
swallowing difficulties in the future, then this
makes it difficult to eat and drink enough to meet
your nutritional needs. Weight loss as a result can
make an MND patient weaker and more vulnerable to
infections. There may also be a risk of food and
drink ‘going down the wrong way’ into the lungs,
which can cause chest infections. A feeding tube will not
slow the course of the disease in someone with MND,
but it is believed to improve their
quality of life.
Do I have to use the feeding tube straight away
or can I still eat and drink normally too?
You may not need to use a feeding tube for a while after
it has been inserted, or tube liquid feed can be used
to supplement what you are eating and drinking via
the normal route. This may mean eating and drinking
small amounts which you enjoy, rather than eating
and drinking because you have to. Using a tube feed
can take the pressure off eating and drinking if
chewing and swallowing has become difficult. You can
also take most medications via a feeding tube.
So, a PEG or a PIG for me? Which is better?
A PEG is a standard and method to do
this procedure but it is not possible in all
patients, in which case a PIG is a very safe
alternative. A PEG is inserted using a telescope
down the gullet. As a result sedation is
required, and patients need to be able to lie
comfortably flat for 30 minutes. This is not a
general anaesthetic, but it makes people drowsy and
they are not able to remember the procedure.
In MND patients with weakness of breathing muscles lying flat might be very difficult, and
such patients might also be very sensitive to even
small doses of sedatives. If a PEG
is felt unsafe to do, then we suggest a PIG instead,
which is performed with respiratory support with an
What does the procedure involve?
To have a PEG, an endoscope (camera) is inserted via
your mouth into your stomach, to view the stomach
lining. When the insertion site for the PEG is
located, a small incision is made under local
anaesthetic in the skin. The PEG tube is passed into
your mouth, down through your stomach and out
through the incision. It will then be secured in
place and its position checked with the endoscope.
PIG procedure similar to the PEG method except
x-rays are used to identify the insertion site in
the stomach and help with breathing is given.
Both procedures are very safe in experienced hands.
Major complications are extremely unlikely, but as
with any medical treatment, there are always some
risks e.g. infection or bleeding. These would be
discussed with you in detail before you decide
whether to go ahead. Your specialist usually makes
the decision for the safest procedure route for you.
Is it difficult to use and look after a
A feeding tube is only pencil-sized and flexible, so
it is not intrusive or visible beneath clothing.
People sometimes worry that it might smell, but this
is not the case at all – remember that the mouth is
connected to the stomach through a similar, just
longer tube and is open to the outside world.
Although it might seem a bit daunting to start with,
people usually adapt well to carrying out basic
care, which involves daily flushing of the tube
with water. It may be that the person with the
tube can take care of this, depending on hand
dexterity, or that his/her carer needs to be
Your Dietitian will discuss with you the different
options regarding the amount, type and method of
feed to decide on an option that would suit you.
Training is provided by a variety of specialists
including dieticians and nursing staff after
having the feeding tube inserted in hospital and there
are health professionals you can contact for advice
or if you have concerns once you go home.
When is the best time to have a feeding tube
When patients highlight that they are experiencing
swallowing problems clinicians will discuss the
various options with them at this time. Some of the
assessment that are routinely carried out in clinic
are designed to identify early signs of swallowing
difficulties so there are methods to support
If you want to discuss this further, please contact Theresa