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Guide to PEG/PIG

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Information about gastrostomy (feeding tube)

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 gullet (oesophagus).
  • PIG stands for per oral radiologically inserted Gastrostomy.

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 anaesthetist present.

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.

The 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 PEG/PIG?

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 involved.  

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 inserted?

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 identifying problems.

Further information?

If you want to discuss this further, please contact Theresa Walsh.

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