- Reference Number: HEY219/2025
- Departments: Endoscopy
- Last Updated: 30 September 2025
Introduction
This leaflet has been produced to give you general information about your procedure. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team who has been caring for you.
Endoscopy Department contact numbers:
Hull Royal Infirmary
Tel: 01482 675707 (direct line)
Castle Hill Hospital
Tel: 01482 622065 (direct line)
What is a Percutaneous Endoscopic Gastrostomy (PEG)?
A Percutaneous Endoscopic Gastrostomy (PEG) is a procedure to allow the placement of a tube into the stomach from outside your body; this can be used for feeding, hydration and medication.
Percutaneous means through the skin.
Endoscopic refers to the endoscope which is a thin, flexible tube with a bright light and a camera at the end. It is passed through your mouth, down your gullet/oesophagus and into your stomach.
Gastrostomy refers to the artificial external opening to the stomach.
Why do I need a Percutaneous Endoscopic Gastrostomy (PEG)?
PEG tubes may be needed due to temporary or deteriorating problems with swallowing. If your swallow is unsafe or variable, then there is a risk that food, liquids or medication can travel into your lungs instead of your stomach. This is called aspiration. If your swallow is unsafe, you may be nil by mouth to reduce the risk of aspiration.
A PEG tube will not change your swallowing problem or disease progression, but it can improve quality of life by providing the nutrition and hydration you need. However, it will not completely protect against pneumonia, as you will still have saliva which could be aspirated but the risks will be greatly reduced.
Sometimes PEG tubes can be indicated for cancers where there may be an obstruction between the mouth and stomach or to allow the stomach to vent air and gastric juices.
A PEG tube can stay in place for years if needed but can also be reviewed for removal. It may be needed for all nutrition, hydration and medication but may also only be needed for a part of these. It is still possible for you to eat and drink with a PEG tube, if you have been advised that it is safe.
PEG tubes can be deemed inadvisable if you have complex anatomy (such as scoliosis), hiatus hernia (where part of your stomach slides above your diaphragm), ascites (excessive fluid around the stomach), infection or problems with clotting/ bleeding. This will all be assessed with consideration of your current health, procedure risk and intended benefits.
What are the alternatives?
For some patients the risks and indications can be less clear, and they may decide to continue to ‘eat and/or drink at risk’. There is always an option to decline the procedure if the risks and benefits are understood. ‘Eating and drinking at risk’ means that you accept that your swallow function is not working properly and there is a chance that you will aspirate which could manifest as pneumonia. This could become life threatening, so it is important to fully understand and discuss the options. However, you can choose to accept this risk and decide to continue with oral intake.
A nasogastric (NG) tube which passes from the nose to the stomach can also be used to bypass the lungs and provide nutrition, hydration and medication. This is usually a short-term solution. It is visible on the face and requires regular position checks to make sure it has not moved. Your doctor or healthcare professional will advise if this is the recommended tube for you.
A PEG tube is more comfortable and easier to manage at home long term. PEG tubes are also more discreet.
A Radiologically Inserted Gastrostomy (RIG) is a similar procedure but performed under X-Ray guidance rather than using an endoscope. It may be more appropriate in some cases
This will not alter the way we treat you and your standard of care will not change. You will need to discuss this and alternatives to this means of nutritional support with your doctor/specialist team.
Can there be any complications or risks?
Minor complications are:
- Problems with gastric content leakage onto the outside skin which can cause irritation and soreness
- Infection at the entry site on the abdomen
- Over-granulation at the entry site, which is where the skin is trying to heal the hole by growing around it.
Major complications are rare and include:
- Problems with breathing during or after the procedure usually due to sedation
- Aspiration
- Bleeding
- Bowel perforation
- Mortality risk 4% – there is a small risk of death that is usually related to the condition you have rather than the procedure itself. The procedure related mortality risk is less than 1%
Other:
There is also a risk of damage to crowned/capped/loose teeth. Although a mouth guard is used, teeth or dental work such as crowns may be broken, chipped, loosened or completely removed by accident. Please inform the nurse on admission of any loose teeth or dental work they need to be aware of.
You will be closely monitored throughout and if there is any cause for concern, the procedure will be stopped immediately.
How do I prepare for the procedure?
In order to get good views of your stomach you must STOP EATING six hours before your appointment time. Continue to drink clear fluids such as water until four hours prior to your appointment time.
If you are taking any of the following medications, please contact the Endoscopy Unit as soon as possible, on the above telephone numbers before you come into hospital.
- Warfarin • Rivaroxaban • Dabigatran
- Edoxaban • Apixaban • Clopidogrel
- Prasugrel • Ticagrelor
If you have any concerns about medication, please contact your GP or speak to the medical team in hospital. If you are taking medication for diabetes (insulin or tablets) please contact the Endoscopy Unit. If you have any allergies or bad reactions to drugs or other tests, please tell the nurse on admission and/or doctor.
Creutzfeldt-Jakob disease/variant Creutzfeldt-Jakob disease CJD – Please inform the department if you have been notified that you are at risk of CJD/vCJD for public health reasons.
PREGNANCY – It is important that you inform us if there is a possibility that you may be pregnant. Any information you share with us will be kept strictly confidential.
What will happen?
On the day of your procedure, you will be transferred from the ward to the Endoscopy Department. Your named nurse who will stay with you throughout your procedure will meet you.
The nurse will explain the procedure to you again and ask any questions or concerns you may have. At this time, we will check your blood pressure, pulse and oxygen levels and ask you a few questions about your general health (this may have been done on the ward before you arrive). Please feel free to ask questions.
We will ask you questions about your general health and work through the health questionnaire you have completed for us.
If you wear glasses or dentures, you will be asked to remove them before the procedure.
The endoscopist will meet you and explain the test to you. You will both sign a consent form unless you have already done this. It is to show you understand what will happen and agree to the procedure being performed. At any point during the procedure, you can withdraw your consent and ask for the procedure to stop. If this happens the endoscopist will stop the test and take the scope out. However, in rare cases the endoscopist will have to continue with the procedure for your safety as stopping the procedure at that point will not be safe.
If you have any queries or worries, please tell us.
What does the procedure involve?
This procedure generally takes place in the Endoscopy Unit. An endoscopist who is specially trained and experienced in performing the procedure will carry out the Percutaneous Endoscopic Gastrostomy (PEG). A senior nurse or doctor who is specially trained and experienced or a trainee supervised by a specially trained nurse or doctor will insert the gastrostomy tube. Occasionally it may need to be performed in an operating theatre or in radiology.
You will be given a single dose of intravenous antibiotic pre-procedure to prevent infection. This procedure is usually done with sedation but can be done with throat spray (local anaesthetic) under special circumstances. Sedation is given to help you to relax during the procedure. You may be aware of what is happening but should feel comfortable. You may not remember having the procedure, as the sedation can affect your short-term memory. It will not have a long term or permanent effect.
The procedure does not take very long but if you have had sedation, you may need to wake up fully first in the recovery area. If you are not a hospital inpatient, then it is generally anticipated that you would stay in hospital for two nights.
If you have dentures, you will be asked to remove them when you go into the treatment room. If you have asked for local anaesthetic spray and it is safe to give it, it will be sprayed into the back of your mouth. This will numb your mouth and the first part of your gullet (oesophagus). The numb sensation will last for about 90 minutes.
To protect your teeth (and our endoscope), a small plastic mouth guard will be placed between your teeth. This will not interfere with your breathing. Sedation will be given at this point if safe to do so. In some cases, an opiate pain killer will also be used. Your pulse and oxygen levels will be continuously monitored. The nurse will gently hold the mouth guard and your head in the right position for the endoscope to be inserted. The nurse may also use a small suction catheter to keep your mouth clear of saliva.
The endoscope is passed through your mouth and into the stomach. This allows viewing inside your stomach and shines a light from inside to find the best position for the PEG tube.
You will be given some local anaesthetic before the small cut is made, which can feel like a nettle sting and the area may be sore afterwards. A wire is then passed through a needle from outside through the cut into the stomach which the endoscope then catches with a snare (like a lasso) and withdraws out of the mouth.
The PEG tube is then attached to the wire and pulled through the mouth into the stomach, where a disc holds part of it inside you and the rest is held in place with a moveable disc on the outside. A small dressing is applied to the PEG site and this should remain in place for seven days then no further dressings are required.
The following diagram should assist with understanding the procedure.
What will it feel like and what happens afterwards?
If you have had sedation, you will be transferred to the recovery room on the trolley to rest and recover, while the nurse monitors your blood pressure, pulse and oxygen saturations. When the tube is first placed, it can feel uncomfortable. Initially, this may be because of wind – it usually settles within a few hours. Some people do find that the discomfort can last for up to a week. Painkillers can be given during this period and should allow you to breathe normally without discomfort. If you are unable to do this, please tell the medical team or contact your GP.
It is quite likely that the back of your throat will feel sore for the rest of the day.
It is important to rest and relax for the remainder of the day. You can have a shower 2 days after your procedure and a bath after one week of tube insertion. If you are an in-patient, you will recover to being awake in the Endoscopy Unit before being transferred back to the ward.
For 4 hours after PEG insertion, you need to remain nil by mouth/PEG and then can start taking water via the tube or orally (if permitted) gradually. If water is well tolerated, you could start having feed and medication down the tube 4 to 12 hours after the tube was inserted.
If you experience any of the following, STOP feed and medication delivery immediately and obtain medical advice urgently (GP, 111, attend A&E or 999)
- Pain on feeding • Prolonged or severe pain post procedure
- Fresh bleeding • External leakage of gastric contents
The hospital dietitians will plan a regimen for feed and hydration, and your medical team/pharmacists will plan when medication needs to be given. You may have been having these via a tube in your nose before the PEG insertion and be well established on a regimen beforehand. Your feed will usually take the form of a commercially prepared liquid diet that will contain all the nutrients that you would receive from a healthy balanced diet. It may have been possible to do some training with you, family and/or carers prior to the tube insertion around the feeding plan and equipment needed. There will also be opportunities to do training after the PEG insertion on the ward or in the community.
The PEG site will need to be cleaned daily once the dressing is removed. 14 days after the procedure the PEG can be advanced and rotated. You or your family/carers will be shown how to do this. This helps to stop the disc on the inside of your stomach getting stuck to the tissue and is called an Advance and Rotate.
Further information
If you require further information about your test your GP, consultant, and the
Endoscopy Department is a valuable source of information.
Further information about your rights with regards to consent can be found in the following documents:
- Department of Health (2001), Guide to Consent for Examination or Treatment
- Department of Health (2001), Consent – What you have a right to expect
- A Guide for Adults. (Available from the Endoscopy Department)
- A Guide for Relatives and Carers. (Available from the Endoscopy Department)
These are free of charge.
Visit the Department of Health’s website at: www.doh.gov.uk and, for consent:
Useful contact numbers:
The Endoscopy Department, Hull Royal Infirmary
Tel: Tel: 01482 674790
Monday to Friday: 8am to 5pm
The Endoscopy Department, Castle Hill Hospital
Tel: Tel: 01482 622065
Monday to Friday: 8am to 5pm
Ward 100 Hull Royal Infirmary
Out of hours Tel: 01482 675100
What do the words in the leaflet mean?
Abdomen – The tummy or belly.
Consent – This is the agreement between you and the endoscopist. You are agreeing to have investigations or treatment and that you understand the purpose, benefits, alternatives and risks. You and the endoscopist during this process usually sign a consent form.
Endoscopy
Department – The place where your procedure takes place.
Endoscope – A tube for looking inside the body.
Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Endoscopy on Tel: 01482 675707
General Advice and Consent
Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.
Consent to treatment
Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.
The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:
- you must be able to give your consent
- you must be given enough information to enable you to make a decision
- you must be acting under your own free will and not under the strong influence of another person
Information about you
We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.
If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.
