Having your PEG Removed

You have been advised to have your PEG tube removed.

Pre Assessment Appointment

Once you have a booking date you will be pre-assessed over the phone. Please ensure you have contact details of your next of kin, escort and  a list of your medicines to hand.  The nurse will go into detail about the procedure, check your medical history and answer any questions you may have.

Preparation

You must not have anything to eat six hours before the examination. Small amounts of water are safe up to 2 hours before the test.

If you have a morning appointment, please do not have anything to eat from midnight but you may have a drink at 6am

If you have an afternoon appointment please take your regular medication with a light breakfast no later than 8am and small amounts of water until 2 hours before your appointment.

On the day of the procedure

When you arrive at Reception you will be asked to take a seat to wait to be called by the admissions nurse. We ask that you don’t arrive early due to space constraints.  Once in admissions they will explain the procedure and go through your pre assessment to make sure there have been no changes in your health. You will then be asked to get changed and prepared to see the Endoscopist. The Endoscopist will go through a consent form with you and ask you to sign it. This is to ensure you understand the procedure and its implications.  If you have any worries or questions don’t be afraid to ask.  The staff want you to be relaxed as possible for the procedure and will not mind answering your queries.

Methods of removal

Endoscopic removal

• This is when the doctor performs a Gastroscopy while you lie on your back or left side. (Similar procedure to insertion of your PEG). The procedure will be explained fully to you and you will be asked to sign a consent form when you are ready.
• The procedure can be done with local anaesthetic sprayed to the back of your throat to make it numb for the procedure or a sedative injection to make you slightly relaxed.
• If you have sedation, it is essential that a responsible adult takes you home and stays with you for 12 hours. Do not drive, operate machinery, drink alcohol or sign any legal binding document for 24 hours after sedation.
• The PEG will be cut close to the skin and gently pushed  into your stomach where it will be caught by a special loop and is then pulled upwards and through your mouth by a gastroscope. This takes a few minutes. It may give you slight discomfort at the back of your throat and bloated feeling in your stomach.

Risks

• Most PEG removals are straightforward. However, occasionally we may find the Internal flange (bumper) is stuck and it cannot be removed at endoscopy. A different procedure may be required at a later date. There is a small risk of minor side effects during and after removal. You may have a sore throat or wind afterwards but this should settle soon.
• Rare complications include: reactions to medication, bleeding and perforation of the oesophagus (making a hole in the gullet).  Please be assured that these complications are very rare and a member of staff will be happy to answer any questions you may have.

Cut and push method

• This is normally carried out by the Specialist Nutritional Nurse.
• This means you do not need a gastroscope to remove the PEG and is the procedure of choice and suitable for most people. No anaesthetic spray or sedation is required. The PEG will be cut close to the skin and internal  flange pushed well  into your stomach. The flange will be passed when your bowels are opened (may take up to a few weeks but should not alter your normal bowel habit).

Risks

• Patients are carefully selected for this method as there is a very small risk of the flange causing blockage in the bowel, but this is rare.

Percutaneous method

• If you have a PEG with water filled balloon keeping it in place, we can remove this by removing the water through a syringe and pulling the tube from the stomach through your skin. No sedation or local anaesthetic is required and it only takes a moment.
• A risk with this procedure is that we may not be able to pull the tube through the skin. Please discuss any concerns or queries about this procedure with the nurse or doctor.

After your procedure

• If you have a sedative injection, your recovery will take longer as you will rest on the trolley until you feel awake and the nurses are happy with your progress.
• If you have had a local anaesthetic spray, recovery is quicker.
•  The doctor will decide when it is safe for you to eat and drink normally again. Usually you may have sips of water after one hour and a light meal after four hours when you go home.
• A small dressing will be covering your skin where your tube has been removed – keep this in place for 48 hours. The tract heals very quickly so another dressing may not be required.
• Do not immerse the site in water for 48 hours to bathe or swim.
• Check for signs of infection – pain, redness, discharge and inform your GP or district nurse if you spot any signs.
• To enable healing, please do not undertake strenuous activity for one week following any type of removal

You will be escorted to the discharge lounge and given refreshments.

A nurse will go through the discharge information, this includes receiving a clear post procedure leaflet and then you will be escorted to the discharge lounge and given refreshments.

Going home

If you are going home after the test it is essential that a responsible adult comes to the department to pick you up and stays with you for 24 hours. (If you have had sedation)

Once home, it is important to rest quietly for the remainder of the day. The effects of the procedure and the sedation should have worn off by the next day; however the effects of the sedation can last for 24 hours, so for this time you must not:

• Drive a car;
• Operate machinery;
• Drink alcohol;
• Sign any legal documents; or
• Be responsible for small children.

You are advised against foreign/remote travel in the 2 week period after this procedure.

Results

Before you leave the department, a nurse or doctor will explain the outcome of your procedure and discuss any changes of medication and further investigations or appointments you may require. It is a good idea to have someone with you when you speak to the doctor after the test.  Due to the effects of the sedation, many people find they forget everything that has been said to them.

Things to report to your doctor

• Severe pain in chest, stomach or abdomen
• Passing or vomiting blood
• Passing black, tarry stools
• Temperature greater than 100°F/ 39°C
• Redness, tenderness and swelling at your injection site that persists for more than 48 hours

Points to remember

• If you are unable to keep your appointment please notify the Endoscopy unit as soon as possible
• It is our aim for you be seen and investigated as soon as possible after your arrival. However the department is busy and your investigation may be delayed. If emergencies occur, these patients will obviously be given priority over less urgent cases.
• The hospital cannot accept any responsibility for the loss or damage of personal property during your time on these premises.

Concerns

If you have any queries regarding the procedure please contact the endoscopy unit between 8am and 6pm Monday to Sunday and the nursing staff will be happy to give you information or advice.

FOLLOWING THIS PROCEDURE YOU MUST NOT DONATE BLOOD FOR 4-6 MONTHS

The reason for this is that your ability to donate blood in the future is dependent upon your diagnosis and the possibility that you might need to undergo further investigations or complete treatments. (British Society of Gastroenterology, 2019)