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Patient guide · Gastroenterology

Percutaneous endoscopic gastrostomy (PEG), endoscopic tube placement for long-term nutritional support.

A PEG is an endoscopically placed feeding tube through the abdominal wall into the stomach — for long-term nutritional support in stroke, motor neurone disease, head-and-neck cancer, dementia and other conditions with unsafe swallow.

Read the key facts
A London gastroenterologist performing an endoscopic PEG placement

Key facts

  • 01

    What it is

    Endoscopic placement of a feeding tube through the abdominal wall directly into the stomach.

  • 02

    Day-case with sedation

    Performed as a day-case procedure under conscious sedation, usually in an endoscopy suite.

  • 03

    Feeds within 4–24 hours

    The feeding regimen is normally established between four and twenty-four hours after placement.

  • 04

    Long-term nutrition

    Designed for long-term nutritional support — weeks, months or years, depending on the underlying condition.

  • 05

    Alternative to NG feeding

    Replaces nasogastric feeding when enteral support is needed beyond four to six weeks.

  • 06

    Multi-disciplinary team

    A nutrition MDT — dietitian, speech and language, gastroenterology, nursing — decides suitability and manages follow-up.

How it’s done

From MDT decision to feeds — what happens, in order.

A PEG is a day-case procedure — the MDT decides, the endoscopist places, the dietitian and nurses run the aftercare.

  1. 01

    Before

    Nutrition MDT decision

    The multi-disciplinary nutrition team confirms that long-term enteral feeding is the right step — often after unsafe swallow on FEES or videofluoroscopy.

  2. 02

    Before

    Consent and pre-procedure fasting

    Written consent covers benefits, risks and alternatives. You will be asked to fast — typically six hours for food, two for clear fluids.

  3. 03

    Before

    Antibiotic prophylaxis

    A single intravenous dose of a broad-spectrum antibiotic is given at induction to reduce stomal infection risk.

  4. 04

    On the day

    Endoscopic gastroscopy

    A gastroscope is passed through the mouth into the stomach under conscious sedation. The stomach is inflated with air to bring it against the abdominal wall.

  5. 05

    On the day

    PEG tube placement

    The gastroenterologist identifies a safe site by transillumination and finger indentation, then places the PEG tube via a percutaneous puncture.

  6. 06

    After

    Post-procedure observation

    You are observed for four to twenty-four hours — pain, vital signs and stoma-site checks — before feeds begin.

  7. 07

    After

    Feeding regimen established

    The dietitian sets a bolus or continuous regimen, and community feeding support is arranged before discharge.

Typical hospital stay: day-case to overnight. Feeds established: 4–24 hours.

What it shows

What a PEG review is looking for.

At every review the team is checking tube position, stoma health, feed tolerance and the early markers of complication.

  • Established PEG tube

    A well-positioned PEG with a patent lumen and a healthy stoma is the expected finding at review.

  • Site infection assessment

    Erythema, discharge or induration around the stoma is checked at each review — most respond to antibiotics.

  • Buried bumper syndrome

    The internal bumper migrates into the gastric wall — presents with pain, leakage or resistance to feeds.

  • Blockage or dysfunction

    Feed residue or medication debris blocks the lumen — flushing, enzyme solutions or replacement is required.

  • Balloon rupture (for balloon PEGs)

    Balloon-retained tubes fail suddenly — an immediate replacement is needed before the tract closes.

  • Position confirmation

    External length markings, aspiration of gastric content and pH are checked to confirm intragastric position.

  • Tract maturation (2–4 weeks)

    The stoma tract matures over two to four weeks — early dislodgement before maturation is a surgical emergency.

  • Red flag: signs of peritonitis or major bleeding — urgent surgical review

    Sudden abdominal pain, guarding, fever or fresh bleeding demands same-day surgical assessment. Do not restart feeds.

Treatment options

The full spectrum of enteral-feeding options.

A PEG is one point on a wider pathway — from short-term NG feeding through to surgical gastrostomy and community support.

  • Nasogastric feed as bridge

    A fine-bore NG tube provides short-term enteral feeding while suitability for PEG is decided.

  • PEG feeding regimen

    A dietitian-led plan sets feed type, volume, rate and free water flushes — reviewed as needs change.

  • Bolus vs continuous feeding

    Bolus feeds mimic meals and free the day; continuous overnight pump feeds suit reduced tolerance.

  • Antibiotic for site infection

    Stoma-site cellulitis is treated with an oral antibiotic and enhanced skin care; sepsis needs IV cover.

  • Endoscopic PEG replacement

    Routine change of a worn or blocked PEG is performed endoscopically once the tract is mature.

  • Surgical gastrostomy

    An open or laparoscopic gastrostomy is the fallback when endoscopy is unsafe or has failed.

  • Nutritional MDT review

    Regular review with the nutrition team adjusts the regimen, screens for complications and plans transitions.

  • Community feeding support

    A structured home-enteral-feeding service delivers supplies, nurse visits and 24-hour helpline access.

Red flags

When to seek urgent help.

PEG is a safe day-case procedure, but a small number of complications need same-day medical or surgical review.

  • Peritonitis post-PEG

    New abdominal pain, guarding or rigidity after placement — a surgical emergency until proven otherwise.

  • Major bleeding

    Fresh blood at the stoma, haematemesis or a falling haemoglobin — needs urgent endoscopic or surgical review.

  • Aspiration

    Coughing, desaturation or a new pneumonia raises the question of feed reflux — pause feeds and reassess position.

  • Buried bumper syndrome

    Loss of external mobility, pain on feeding and leakage — needs endoscopic assessment and tube exchange.

  • Persistent tube leakage

    Ongoing peristomal leakage risks skin breakdown and infection — needs stoma review, not simply a larger tube.

  • Site infection with sepsis

    Spreading cellulitis, systemic upset or fever needs IV antibiotics and same-day medical review.

  • Necrotising fasciitis (very rare)

    Rapidly spreading pain, crepitus or discolouration of the abdominal wall — a surgical emergency.

  • Refractory dislodgement

    A dislodged PEG before four weeks of tract maturation is a surgical emergency; after maturation, replace within hours.

  • Tube-tract fistula

    A persistent gastro-cutaneous fistula after PEG removal may need endoscopic closure or surgical repair.

Reading your report

A PEG procedure report keeps to four parts. Read the impression first.

Whatever the finding, the report follows the same structure.

A gastroenterologist reviewing a PEG procedure report on a clinical workstation in Central London

A quiet reminder

The report is written for your doctor and nutrition team — and that’s normal.

If you would like us to talk you through it before your follow-up, just ask.

  1. 01 Header

    Indication and MDT decision

    Your details, the underlying diagnosis (stroke, MND, head-and-neck cancer, dementia) and the nutrition MDT recommendation for PEG.

  2. 02 Technique

    Procedure and sedation

    Sedation used, antibiotic prophylaxis, endoscopy findings and the pull-through or push technique of PEG placement.

  3. 03 Findings

    Tube position and stoma

    External length markings, internal bumper position, transillumination, and any peri-procedural complications.

  4. 04 Impression

    Feeding plan and follow-up

    When feeds start, the initial regimen, community feeding support, and the nutrition MDT follow-up interval.

Frequently asked

Everything we get asked about PEG.

Quick answers on who needs a PEG, how long it lasts, whether you can still eat, and what to watch for.

  • What is a PEG tube?

    A percutaneous endoscopic gastrostomy (PEG) is a feeding tube placed through the abdominal wall directly into the stomach using an endoscope. It provides long-term nutritional support in people who cannot swallow safely or take enough by mouth.

  • Who needs a PEG?

    PEG is considered for people with an unsafe swallow or inadequate oral intake expected to last longer than four to six weeks — commonly in stroke, motor neurone disease, head-and-neck cancer, advanced neurological disease and selected dementia patients. The nutrition MDT decides.

  • How long does a PEG last?

    A standard PEG tube typically lasts one to two years, sometimes longer. Balloon-retained replacement tubes are usually changed every three to six months. Your nutrition team plans the schedule.

  • Can you still eat with a PEG?

    If your swallow is safe for some textures, yes — many people continue to eat and drink for pleasure alongside PEG feeds. If your swallow is unsafe, oral intake will be restricted on speech-and-language advice.

  • What are the risks of PEG placement?

    The main risks are stomal-site infection, bleeding, aspiration, tube dislodgement, buried bumper syndrome and — rarely — peritonitis, colonic injury or necrotising fasciitis. Antibiotic prophylaxis and careful technique reduce these.

  • What is buried bumper syndrome?

    Buried bumper syndrome is when the internal retaining disc migrates into the gastric wall, causing pain, leakage, resistance to feeds and sometimes bleeding. It needs endoscopic assessment and usually tube replacement.

Sources

Guidelines and references.

Reviewed by Pulse Atlas Editorial Board () · Last reviewed 2026-07-30 · Next review 2027-07-30 · 6 min read.

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The honest picture around percutaneous endoscopic gastroscopy in London

With percutaneous endoscopic gastroscopy, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The NHS route for percutaneous endoscopic gastroscopy is thorough, but the queue is real. Most patients we speak with have been told to expect anywhere from a handful of weeks to several months, depending on their local trust and how the referral is graded. Going private in London usually collapses that window to a matter of days — often the same week if the diary allows. It isn’t about jumping a queue so much as buying time back while you still have the flexibility to plan around it.

The mechanics are straightforward: a consultant appointment, any tests done at a nearby CQC-registered site, and a written report back within a few days. London’s density of private diagnostics — Marylebone, the City, Chelsea, Canary Wharf — means most patients can find something that fits around work without a cross-town trek. For percutaneous endoscopic gastroscopy specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.

The value of going through a concierge for percutaneous endoscopic gastroscopy isn’t access — anyone with an insurer or a credit card can get a private appointment in London. The value is knowing which consultant reads this particular presentation best, which unit turns reports around fastest, and which pathway won’t hit a dead end if the findings point somewhere unexpected.

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