The Endoscopy Department
Plymouth Hospitals NHS Trust
L7 Derriford Hospital
Plymouth
HELP LINE/ENQUIRIES: 01752 792211 (9 am to 5 pm Mon-Fri)
HAVING A PERCUTANEOUS ENDOSCOPIC GASTROSTOMY
(PEG)
Your appointment time and date are detailed on the enclosed
admissions letter or will be arranged between the ward and Endoscopy.
Please bring this booklet and consent form with you
Please read this booklet carefully, it gives a guide to the procedure, and
contains a consent form, which you can sign prior to the
procedure if you understand all the information.
The consent form is a legal document, so do not sign it if there is
anything you do not understand or wish to discuss. The consent
form can be signed when you attend for the appointment, after we
have answered your questions.If you are unable to keep this
appointment or have any other queries, please ring the help line number
above. A checklist of the key information is provided at the end.

If you are a carer, have special needs, or if you need help reading this
information (eg: if English is not your first language) please contact
the help line number above.
INTRODUCTION
This leaflet will help you understand what happens when you have a PEG
tube placed. At the back of this leaflet there is a consent form for you to sign
once you have read the information. You can sign this form at home or if you
have any further questions you can sign it in the department on the day of the
procedure, following discussion with the endoscopist.
Please bring the consent form with you on the day of your procedure.
WHAT IS A PEG AND WHY DO I NEED ONE?
Due to swallowing problems you may not be receiving enough nourishment to
keep yourself in good health.
The PEG is a soft plastic tube which protrudes through your stomach wall.
Connectors are attached in order to prevent it falling out. Feeding adaptors
are attached to the end. The PEG tube will allow you to be given food, fluids
and drugs more safely, reducing the risk of aspiration (choking) into your
lungs. The PEG tube will allow the food, fluids and medications to be
introduced directly into your stomach, avoiding the need for you to swallow or
the inconvenience of having a tube passed through your nose (a naso-gastric
tube). Depending on your particular medical condition, you will receive either
all or part of your nutritional requirements and medications in liquid form
through your PEG tube.
The PEG is placed by passing a long flexible tube (a gastroscope, the
thickness of your little finger) through your mouth, down the oesophagus
(gullet) into your stomach.
The procedure will not interfere with your breathing.
WHAT ARE THE RISKS OF HAVING A PEG?
The risks will be addressed by the doctor who discusses the procedure with
you, but the main problems are:There is a tiny (1 in 1,000) risk of bleeding or perforation (tearing) of the gut. If
this does occur, it may require an operation.
Local infection, displacement of the tube, perforation of the lining of the
oesophagus (gullet) or stomach and rarely peritonitis (inflammation).
A sore throat is common and should resolve after a few hours.
A reaction to the sedative drugs used can also be another complication. There
is also a risk to crowned teeth and dental bridgework.
WILL I NEED SEDATION?
This procedure is undertaken with sedation.
Sedation is an injection into a vein on your hand or arm. It does not put you to
sleep but makes you feel relaxed and sleepy. Sedation also causes temporary
forgetfulness, so you may not remember much about the procedure, or what
was said to you afterwards.
WILL I NEED SOMEONE TO TAKE ME HOME?
Usually you need to stay in hospital at least overnight or until your feeds have
been established.
WHAT PREPARATION DO I NEED?
Please avoid using nail polish as it interferes with equipment we use to
monitor your oxygen by a finger probe. If you wear contact lenses please
bring the appropriate containers. If you have a tongue stud, you will be asked
to remove it. In order for good views of the stomach to be obtained it is
essential that the stomach is completely empty. You must be nil by mouth for
at least 6 hours prior to the procedure. Feeds must also be stopped for the
same period.
Please follow these instructions:Morning appointment
Have nothing to eat from midnight prior to the procedure. Water only (in small
amounts) may be taken up to 1 hour before your appointment. Essential
medication may be continued (see below).
Afternoon appointment
Eat a normal breakfast before 8 am or feed and then no more food is allowed.
Water only (in small amounts) may be taken up to 1 hour before your
appointment. Essential medication may be continued (see below).
DO I KEEP TAKING MY TABLETS?
Take all medications as usual, however, please avoid taking iron tablets
for 1 week before the procedure. Please bring details of all drugs you are
taking, a list of tablets or repeat prescription. This is important especially if you
take anti-inflammatory painkillers drugs (eg: Nurofen).
If you are on Warfarin, or if you on either clopidogrel
(Plavix) or clopidogrel (Plavix) alone please contact the Endoscopy Unit
now for instructions – it is most important that you do this, as failure to
do so could result in a delay in having your procedure.
WHERE IS THE ENDOSCOPY DEPARTMENT?
The Endoscopy Unit is situated on Level 7, on the right-hand side
down the main corridor.
WHAT HAPPENS WHEN I ARRIVE IN THE ENDOSCOPY DEPARTMENT?
When you arrive a nurse will greet you, take some details, then discuss and
explain the procedure. Please feel free to ask about anything that may be
worrying you regarding the procedure; remember we are here to help. The
nurse will explain when you will need to be collected. You will then be shown
to the changing area and asked to undress and put on a gown and dressing
gown.
If you have signed the consent form at the back of this leaflet, it will be taken
and attached to your medical notes. If, having read this leaflet, you are still
unsure about any aspect of the procedure, you can discuss it with the
endoscopist before signing the consent.
WHAT HAPPENS IN THE TREATMENT ROOM?
A nurse will remain with you throughout the procedure. You will be asked to
sit on the couch where the endoscopist will discuss the procedure and answer
any questions.
You will be asked to remove spectacles and any dentures. The nurse may
spray the back of your throat with a local anaesthetic prior to your lying down
on the couch on your left side. A plastic mouth guard will be placed between
your teeth or gums in order to keep your mouth open.
Sedation will be given at this point. Oxygen will be given through a small
sponge placed in your nose, and a probe will be placed on your finger to
monitor your pulse and oxygen saturation. The endoscopist will pass the
gastroscope through the mouthpiece into your stomach and you will be asked
to swallow it to help it pass over the back of your tongue. Any saliva will be
removed from your mouth using a small suction tube. You may feel the doctor
putting air into your stomach to distend it. This allows a check to see if your
stomach is working properly and that there are no reasons for not having a
PEG tube.
An injection of local anaesthetic will be given at the point where the PEG tube
enters through your stomach wall and a small incision (cut) is made for the
tube to go through. The gastroscope is then removed quickly and easily, and
replaced by a soft plastic feeding tube (the PEG tube) which is drawn over
your tongue and down into your stomach wall. Connectors are attached in
order to prevent it falling out. Feeding adaptors are attached to the end.
WHAT HAPPENS AFTER THE PROCEDURE?
You will be transferred to the recovery room and looked after by a trained
nurse until you are returned to your ward to recover. It may be likely that your
throat will feel sore and in addition your stomach may feel a little sore and
bloated. Such discomforts, however, will pass, usually without the need for
medication.
Over the next few hours and days your PEG tube will be flushed with sterile
water and feeds gradually introduced. The site around the PEG will be kept
clean and dry. Your carer will be taught how to manage your PEG tube and
the Dietician will organise all your requirements for your feeding regime.
If you have never had a PEG placed before, you will normally need to stay in
hospital until your feeding regime is established. If you are allowed home you
must have a responsible adult to collect you from the department and stay
with you for at least 12 hours.
It is important that both you and the person helping you after the
procedure understand that for 24 hours you should not:Drive a vehicle
Operate machinery
Drink any alcohol
Sign any legal documents
HOW LONG DOES THE PEG TUBE STAY IN FOR?
The life of the PEG varies from patient to patient. Your PEG should last for 18
to 24 months. Following this, a replacement PEG will be discussed with you. If
Your ability to swallow improves sufficiently for you to be able to take an
adequate amount of food once again, the PEG tube may be removed. This
decision will be made only after discussion with the medical team who are
looking after you.
ADVICE ABOUT VALUABLES
We cannot accept responsibility for valuables so please avoid bringing them
with you. You may however need some change for the car park and any
prescription if required.
APPOINTMENT TIMES
We try to keep delays in appointment times to a minimum. Sometimes
procedures take longer than expected or emergencies arise, delaying the time
of your procedure. We will endeavour to keep you informed of any delays
where possible.
If you require further information or advice regarding your procedure, please
contact your GP or the Endoscopy Department Help line on 01752 792211
between 9 am and 5pm.
CHECKLIST AND KEY POINTS TO REMEMBER
 Bring this leaflet and consent form with you.
 If you understand and are happy with the information in this
leaflet, please sign the consent form before coming for your
procedure.
 If you are on Warfarin please bring your anticoagulation record
booklet. Please have your INR checked at your GP Practice the
day before your appointment.
 Please bring details of all drugs you are taking ie: a list of tablets
and/ or repeat prescription.
 Have nothing to eat or drink before the procedure but take
essential medication. (You must be nil by mouth for 6 hours).
 Please bring your own dressing gown