A PEG (percutaneous endoscopic gastrostomy) is a soft feeding tube that passes through the tummy wall straight into the stomach. It is placed with the help of a gastroscopy, usually under sedation and local anaesthetic, and allows liquid feeds, water and medicines to be given when a person cannot eat or drink enough safely by mouth.
There are two main ways to place the tube: the pull method and the push method. Both are explained below.
Who may need a PEG
- Swallowing difficulty after a stroke, or with conditions such as Parkinson’s disease or motor neurone disease, where food or drink may go into the lungs
- Cancer of the head and neck or the food pipe, including before or during radiotherapy, when swallowing becomes painful or narrowed
- People who need tube feeding for more than a few weeks. For shorter periods, a tube through the nose (nasogastric tube) is often used instead. See nose tube or PEG.
Whether a PEG is right for a person is a decision made together with the patient and family. For people with advanced dementia, a feeding tube may not improve comfort or survival, so the choice needs careful discussion.
The pull method
This is the traditional way to place a PEG.
- A gastroscope is passed into the stomach, and air is gently put in so the stomach lies against the tummy wall.
- The best spot is found by seeing the scope’s light shine through the skin, and by pressing on the tummy and watching the dent from inside.
- After a local anaesthetic, a small cut is made and a needle is passed through the skin into the stomach. A thin wire is threaded through the needle.
- The scope grasps the wire and brings it up and out through the mouth.
- The feeding tube is tied to the wire. The wire is then pulled from the tummy side, drawing the tube down through the mouth, the food pipe and the stomach, and out through the skin.
- A soft disc (inner bumper) on the end of the tube sits against the inside of the stomach wall, and an outer holder keeps it in place on the skin.
The pull method leaves a long tube coming out of the tummy. Because the tube passes through the mouth and throat, it is less suited to people with a narrowing of the throat or food pipe, or with cancer there.
The push method
In the push method (also called the introducer or direct method), the tube goes straight in through the tummy wall and does not pass through the mouth. Its main advantage is that a low-profile button (such as a MIC-KEY button) can be placed right away, instead of a long tube.
- A gastroscope is passed into the stomach to watch from inside and to choose the spot, as in the pull method.
- The stomach is first fixed to the tummy wall with two or more small anchors (T-fasteners), placed through the skin with a needle. These hold the stomach in place while the opening forms.
- After a local anaesthetic, a needle and wire are passed into the stomach between the anchors, and the opening is gently widened.
- The length of the opening through the tummy wall is measured, and a low-profile button of the right size is pushed in. Its balloon is filled with water inside the stomach to hold it in place.
A button sits almost flat on the skin, with no long tube hanging from the tummy. A feeding extension is clipped on only during feeds, so it is neater, less likely to be pulled, and easier for active patients and carers. Because the tube does not pass through the mouth, the push method also suits people with a narrowed throat or food pipe, for example with head and neck or oesophageal cancer. A thin scope is still used to see inside the stomach. The anchors are usually removed or fall away after a few weeks, once the opening has healed. Dr Chia will explain which method suits you.
| Pull method | Push method | |
|---|---|---|
| Passes through the mouth | Yes | No |
| Type of tube | Long PEG tube | Low-profile button from the start |
| Holds the tube inside | Soft disc | Water balloon |
| Comfort | A long tube outside the tummy | A flat button; more comfortable overall |
| Risk of being pulled out | Higher | Lower |
| Changing the tube | Every 6 to 9 months | Every 6 to 9 months |
In Dr Chia’s practice, the push method with a button is by far the more popular choice, because there is less risk of the tube being pulled out and it is more comfortable overall.
Nose tube (NG) or PEG?
A nasogastric (NG) tube is passed through the nose, down the back of the throat and food pipe, into the stomach. It is placed at the bedside without sedation, and is usually the first choice when tube feeding is expected to last only a few weeks. When feeding is likely to be needed for longer, a PEG is usually more comfortable and more reliable.
| NG tube (through the nose) | PEG (through the tummy) | |
|---|---|---|
| How it is placed | At the bedside, no sedation | A short procedure with a gastroscopy, under sedation |
| Best for | Short-term feeding, usually a few weeks | Longer-term feeding, usually more than about 4 weeks |
| Comfort | Can irritate the nose and throat; some find it hard to tolerate | Usually more comfortable once healed; nothing in the nose or throat |
| Appearance | Visible on the face, taped to the nose | Hidden under clothing |
| Falling out or being pulled | Common, especially in confused patients; it then has to be put back | Much less likely, especially with a button |
| Checking position | Must be checked each time it is put in, and before feeds | Fixed in place; no routine position checks |
| Swallowing practice | The tube sits in the throat during practice | The throat is free for swallowing therapy |
| Changing | Every few weeks, or whenever it comes out | Every 6 to 9 months, usually at the clinic |
Neither tube completely prevents chest infection from saliva or from feed coming back up, so keeping the head raised during and after feeds matters with both. Small amounts of food by mouth may still be allowed with either tube, if a speech therapist finds it safe.
Before the procedure
- No food or feeds for about six hours beforehand.
- Tell the clinic about blood thinners, diabetes medicines and allergies. Some medicines need to be adjusted or paused, and a blood test may be done to check clotting.
- A dose of antibiotic is usually given beforehand to lower the risk of infection at the tube site.
- Dr Chia will go through the reasons, the method and the risks with the patient and family before consent is signed.
During the procedure
The procedure is done under sedation, with local anaesthetic to numb the skin. It usually takes about 20 to 30 minutes.
After the procedure
Some soreness around the tube is common for a few days, and is eased with simple pain relief. Water and then feeds are started through the tube a few hours later, following the team’s instructions. Most patients who are already in hospital continue their stay; others usually stay for a short observation period. The nurses and dietitian will show the family how to give feeds and care for the tube.
Caring for the tube at home
- Keep the head up to at least 30 to 45 degrees during feeds, and for a while after. This lowers the chance of feed going into the lungs.
- Flush the tube with water before and after feeds, and before, between and after medicines.
- Medicines: use liquid forms where possible, or crush tablets finely and dissolve them in a little water. Give one at a time, and never mix them into the feed. Ask before crushing, because some tablets must not be crushed.
- Daily skin care: wash around the tube with warm water and mild soap, then dry well. Most skin problems come from moisture. Once healed, the site usually needs no dressing.
- Turn the tube a full circle once a day once the site has healed, and check that it moves in and out a few millimetres. Too tight causes sores; too loose causes leaks.
- Never let the tube be pulled. Keep lines tucked away, and take care when turning, dressing or moving the patient.
- If the tube blocks, gently push and pull with warm water in a syringe. Never use sticks, wires or fizzy drinks.
A little pink, moist, raised skin around the tube is common and is not an emergency. Mention it at the next review.
If the tube falls out
The opening can start to close within hours. Cover it with clean gauze or a clean cloth and come to the clinic or hospital straight away; after hours, go to the nearest emergency department. Bring the old tube with you. Do not push it back in yourself, especially in the first few weeks, when the opening has not fully healed.
When to seek help
- Coughing, choking or breathlessness during or after feeds: stop the feed, sit the patient up, and get help straight away
- Fever, or vomiting, or a swollen, hard tummy
- Spreading redness, pus or bleeding around the tube
- Stomach contents leaking around the tube
- Pain during feeds, or a tube that will not turn
- A blocked tube that warm water will not clear
Changing the tube
With either method, the tube is usually changed every 6 to 9 months. A pull-type PEG tube is often replaced with a low-profile button through the same opening, without another gastroscopy in many cases. With the push method, the button is already in place from the start, and is changed at the clinic. Buttons are changed every 6 to 9 months, and the balloon water may need checking in between. If the patient gains or loses a lot of weight, a button may need re-sizing.
Is it safe?
PEG insertion is a common procedure. Minor problems such as soreness, mild infection or leakage around the tube are the most frequent, and usually settle with care. Serious complications, such as bleeding, injury to the bowel, infection inside the abdomen, or feed going into the lungs, are uncommon. If the outer holder is kept too tight for a long time, the inner disc can sink into the stomach wall, which is one reason the tube is turned and checked daily.
Insurance
Dr Chia is on the specialist panels of AIA, Great Eastern, HSBC Life, Income, Prudential, Raffles Shield and Singlife for Integrated Shield Plans, and on many corporate insurance panels (see all panels). Check your coverage with your insurer.
General information only. Reviewed by Dr Chia Chung King, 2026-11-07. Book a consultation.