Difference Between G Tube And Peg Tube

PEG tubes (Percutaneous Endoscopic Gastrostomy tubes) allow patients to receive the nutritional needs that their bodies cannot obtain through routine consumption. This article will provide an overview of the different types of feeding tubes including PEG Tubes.

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Difference Between G Tube And Peg Tube

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PEG tubes (Percutaneous Endoscopic Gastrostomy tubes) allow patients to receive the nutritional needs that their bodies cannot obtain through routine consumption. This article will provide an overview of the different types of feeding tubes including PEG Tubes.

What is a PEG tube?

PEG tubes, or Percutaneous Endoscopic Gastrostomy tubes, are feeding tubes made of silicone or polyurethane that can hold up against erosive gastric secretions. PEGs are placed in the abdomen, usually the right upper quadrant, below the xiphoid process and ribs.

PEG Tubes are used for long-term enteral feeding or indications that require supportive feeding for greater than 30 days1.

Difference Between a PEG Tube and a G Tube

A PEG tube is a type of G tube or gastrostomy tube, that is specifically placed in a patient through an endoscopic procedure called a Percutaneous Endoscopic Gastrostomy. Gastrostomy tubes are enteral feeding tubes that pass through the abdominal wall and directly into the stomach.

Types of Feeding Tubes

There are two classifications of feeding tubes, those for short-term feeding, less than 4 weeks, and long-term feeding. 
In addition to PEG tubes, other long-term feeding tubes include (not exhaustive)2:

Type of Feeding Tube
Description
Percutaneous Endoscopic Jejunostomy Tubes (PEG-J) These tubes are essentially PEG tubes that contain an extension tube that goes into the small bowel as opposed to ending in the stomach like the PEG tube.
Radiologically Inserted Gastrostomy tubes (RIG).  These are PEG tubes that are placed in patients with contraindications for standard PEG tube placement, such as patients with obstructive tumors
Jejunostomy Tube (J-Tube) A tube inserted directly into the jejunum (small intestine) for feeding or medication administration when the stomach is not accessible.

Some examples of short-term feeding tubes include naso-gastric (NG) and naso-jejunal (NJ) tubes, but there are several others. These tubes enter through the nose, and can be uncomfortable for the patient, so they are used on a short-term basis

Parenteral Nutrition

Feeding tubes provide nutrition enterally, but another option for patients is parenterally or intravenously. Usually, a central line or PICC line is placed for these patients.

These types of IV lines can last for months or even years, without damaging peripheral veins. Parenteral nutrition is a complicated mixture that the pharmacy mixes under sterile conditions. Conditions that may require parenteral nutrition are3

  • Very severe illness
  • Not able to tolerate enteral nutrition
  • Have had part of stomach or esophagus removed
  • Fistula in stomach or esophagus

PEG tube Indications

When a patient has dysphagia, anorexia, or an aspiration risk they will receive a PEG tube. Some patients may need a PEG tube for the rest of their lives, or only for a period of time. There are several conditions that lead to this issue4:

  • Stroke
  • Birth defects of the mouth, esophagus, or stomach
  • Esophageal cancer
  • Head/neck cancer
  • Brain injury
  • Cystic fibrosis
  • Dialysis
  • Chronic illness such as cancer

Contraindications for PEG tube may include3:

  • Bowel blockage
  • Severe illness or diarrhea

Benefits/Risks to having a PEG tube

The clear benefit of PEG tubes for patients, is the fact that they will receive balanced nutrition to meet their needs. However, they aren't without risks such as the following5:

Placement of G-Tubes

Gastrostomy tubes can be placed in surgery by a surgeon, in radiology, or most commonly, by a gastroenterologist during an EGD (esophagogastroduodenoscopy)6.

PEG tubes are placed during an endoscopy, via a small incision in the stomach, allowing for the tube to be placed under local anesthesia. The location of the incision where the tube is placed is called a stoma. A balloon is then blown up on the end of the tube to hold the tube in place.

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(Image Source)

The other methods for G tube placement are

  • Laparoscopic technique is done by making small incisions in the abdomen.
  • Open surgery with larger incisions.

Of these three methods, the PEG tube is the most common7.

Prior to placement, the nurses and medical staff will assess the patient and take a medical history. They may order tests prior to placing a g-tube such as a swallowing evaluation. Blood tests may be done to make sure that the patient's electrolytes and bleeding factors are within normal limits and that their heart and lungs are strong enough to withstand sedation.

G-Tube Considerations

Feeding tubes can stay in until they develop a problem, or the patient no longer needs it. If a patient flushes and takes care of the tube and their skin, then it can last a long time. One study showed that 95.1% of peg tubes last a year 68.5% last five years8.

Complications that caused replacement earlier than the normal time can be infection, the bumper getting buried in the muscle layers, and broken or cracked tubes8. The tubes can also become clogged or stretched out causing the need for a new one.

The diameter of the tube is usually 20, 22, or 24 french. Replacement peg tubes can be even more prominent with a 26 or 28 french diameter. There are tubes that have several inches that stick out from the abdomen. These are flexible, making it easy to put a dressing over it so it doesn't show.

Low-profile Buttons

There are also low-profile replacement peg tubes that lie up against the abdomen, these are called mic-key buttons or mic-key tubes. For young persons, especially children these can be easier to hide under clothing and thus help them with the social stigma of tubes. However, button PEG tubes need to be replaced every six months and are also more expensive.

Patient Care/Self Care 

If the patient is well enough, they can be taught to do their own self-care and feedings. Family and caregivers should always be taught how to perform PEG tube care as a backup whether the patient is able or not. Teaching should begin at the initial office visit, or if the patient is in the hospital the nurse will begin preparing and teaching as soon as a PEG tube is ordered. Teaching will continue throughout the process, and reinforcement should be given at any time, along with follow-up care.

Things that the patient will need to know9:

  • Signs and symptoms of infection
  • How to administer food through the tube
  • How to administer medications through the tube
  • Activity level
  • What to do if the tube stops working/or gets pulled out

The site should be gently cleaned at least every day with mild soap and water and then dried thoroughly. The tube can be covered with a small amount of gauze for protection and to help hide it under clothes. Self-image is important to consider with these patients. Some patients will have difficulty with the change in their appearance and will need extra consideration. 

The patient needs to be instructed on the signs and symptoms that require a call to the healthcare provider9:

  • Any bleeding
  • Signs of infection
  • Blockage
  • Leakage
  • Diarrhea
  • Pain
  • A swollen/hard belly an hour after feeding
  • New prescriptions for unrelated medical conditions
  • Feeding refluxes up into the mouth

Patients should have their head elevated at least 30 degrees for feeding or be sitting up. An important step in teaching patients is checking for gastric residuals. This is important because if the residual is more than 200cc10, the feeding should be delayed until the residual is less than 200cc. If the residual remains 200cc or higher, the patient may have delayed emptying or a blockage and should call their physician. 

Mouth care for peg tube patients is critical since they may not get anything by mouth. Brushing teeth and keeping the mouth from getting too dry is essential for oral health. 

Anecdotal Tips

There can be an ethical aspect to the placement of a peg tube in certain patients. Nurses see the angst that sometimes is accompanied by giving the green light to the placement of a peg tube. When a patient hasn't made their end-of-life decisions known to their family with a living will or through conversions, then the family is left with trying to do what they think is best. 

When the peg tube is part of the treatment for the patient and the prognosis is not good, the patient and family may look solely to the doctor for guidance. If the patient is in the hospital and needs to go to an extended care facility, they have to have a peg tube placed in order to be admitted by the long-term care facility. This doesn't allow for refusal if there is no other living arrangement. 

Prolonging life with the use of a breathing machine or artificial feeding is a personal decision that should be made while the patient is able to make their own decisions through a living will. However, everyday nurses see these decisions being made by families who may have low health literacy and are not aware of all the repercussions or what the alternatives may be. Physicians may not present all sides of the decision or may leave out vital information. They are not perfect, and they sometimes aren't comfortable with these uncomfortable conversations.

Experienced nurses have seen a patient receive the peg tube and then soon be transferred to an extended living facility only then to pass away within a day or two. Sometimes they pass away before leaving the hospital. It is these situations that beg the question of whether it was worth putting a dying patient through the sedation and procedure, as well as the cost. These are very intimate decisions that can cause the patient's family a lot of stress. 

Conclusion

Being ill or having cancer is life-changing. All too often end-of-life decisions are not made because they are uncomfortable. However, it is much easier to make these wishes known while a person can, rather than leaving the family to guess. Having a peg tube is often, but not always an end-of-life palliative measure. Religion and spiritual considerations must also be considered. PEG tubes give much-needed nutrition to patients who cannot eat food due to facial, esophageal, or gastric issues. Sometimes the reason a patient gets a PEG tube is that they are severely anorexic due to cancer. Whatever the reason, these patients and families will need education about the PEG tube. The nurse plays a large role in instructing patients and should be educated on how to take care of a PEG tube.

STAFF NOTE: Original Community Post 

This article was created in response to a community post. The comments and responses have been left intact as they may be helpful. Here's the original post:

Quote

Could someone tell me the difference if there is any? Any different care of either? Mostly thinking of patients who have them at home. Thanks in advance for your help.

References

  1.  Rafferty GP, Tham TC. Endoscopic placement of enteral feeding tubes. World J Gastrointest Endosc. 2010;2(5):155-164. doi:10.4253/wjge.v2.i5.155
  2. https://www.cancerresearchuk.org/about-cancer/coping/physically/diet-problems/managing/drip-or-tube-feeding/types
  3. https://my.clevelandclinic.org/health/treatment/4911-percutaneous-endoscopic-gastrostomy-peg
  4. https://medlineplus.gov/ency/presentations/100125_2.htm
  5. https://www.asge.org/home/for-patients/patient-information/understanding-peg
  6. https://www.uptodate.com/contents/gastrostomy-tubes-placement-and-routine-care
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4069302/
  8. https://academic.oup.com/pmj/article-abstract/94/1114/469/6959126?redirectedFrom=fulltext
  9. https://medlineplus.gov/ency/patientinstructions/000900.htm
  10. https://www.myshepherdconnection.org/tube-feeding-guide
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Brenda F. Johnson

About Brenda F. Johnson, MSN

Gastrointestinal Columnist
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PEG stands for percutaneous endoscopic gastrostomy tube. Most are now placed in either the GI lab, or in interventional radiology. The procedure starts off with an EGD, where they look at the stomach from inside, then shine a light thru, if the light is visualized, then a small stab wound is made, and the catheter can be placed that way. This is just an abbreviated version of how it is done, steps were left off.

The regular G-tube, or gastrostomy tube is normally placed in the OR and requires a surgical procedure. It is placed in the OR when it is done in conjunction with another surgery, at least in most cases.

Care of both of the tubes is essentially the same. The most important fact is that if the tube comes out, do not wait until the next day to do something about it, make sure that it is either replaced as soon as possible, or if the patient is at home, at least insert a red Robinson catheter or even a foley catheter into the hole as soon as you can. If the G-tube procedure is fairly new, that hole will close up rather quickly and you may need to send the patient for another procedure if you wait until the next day.

Think back to when you had your ears pierced, if you ever did. You always made sure that you had something in there in the beginning, or the hole would close up rather quickly.

Hope that this helps.

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Just to add to this, a PEG tube usually has a mushroom shaped device on the end that holds it in the stomach and makes it very difficult to fall out. Most doctors prefer this style to allow for proper healing. Some doctors prefer to place a long PEG tube and some are now starting to place a PEG button, with the same mushroom shape but the extension tube can be removed. The button is more discrete and you don't have to worry about the long tubing when it's not in use. The tubing on the PEG button does not lock into place so if the patient pulls on it, it will easily come right off. It might cause a mess but it protects the stoma site while it's healing. The most common type of PEG button is the Bard button made by AMT. You can do a search on it to see pics.

After a couple of months the PEG tube or button is often removed and replaced with a balloon type button. The PEG tube/button must be pulled out by force and it's painful and scary but it only lasts a few seconds. Then the balloon type button is inserted. Instead of a mushroom, it has a balloon filled with water that can be easily removed and changed at home. The most common brand is Mic-key button. Another one is the AMT Mini Button. There are a few others but these are the most commonly used. The extension tube twists and locks into place to prevent messes during feedings. Very convenient!

The general term is G-tube or G-button and that can include PEG tubes and buttons. The "PEG" term is to specify that it was placed during a PEG procedure.

Hope that helps. ?

Darshani (not a nurse yet but mama to a gtube kid)

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Though both terms are often used interchangeably, g-tube implies tube placed in the stomach only while peg tube may be tube placed in the stomach, duodenum, and jejunum.

Learn about the different types of feeding tubes.

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Also, the wonderful thing about using the Button (MicKey) is that it has a non reflux valve inside the "keyhole" site where you align the removable tubing for the actual feeding/bolus administration. It prohibits the gastric juices from spilling out onto the abdomen. Gastric juices are very caustic and the original peg tube placement as stated before has a longer extension which can get in the way, be pulled out accidentally as in the case of confused or defiant patients. In our practice, the most common patient populations requiring placements of the tubes were post CVA patients. They are often confused or maybe annoyed by the longer extension of tubing and required using an abdominal binder of sorts just to keep them from pulling out the initial tube.

I am a practicing GI nurse (15 yrs in the field) and have an adult daughter with a TBI who I just so happened to change out the MicKey for this evening. From personal experience, I always encouraged my physicians to replace older pegs with the MicKey or similar devices (low profile) as we call them. They also are less noticeable underneath clothing.

Hope this helps.

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josville said:
Though both terms are often used interchangeably, g-tube implies tube placed in the stomach only while peg tube may be tube placed in the stomach, duodenum, and jejunum.

A gastrostomy, G, or PEG tube is always in the stomach. A gastrojejunostomy consists of two tubes in one. The larger stops in the stomach so decompression or medication administration may be done while the smaller tube is advanced into the duodenum or jejunum where nutrition is delivered. A jejunostomy is placed in surgery into the jejunum.

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Specializes in ER, Med Surg, Ob/Gyn, Clinical teaching.

Thank you for sharing this explanation... I find this information very helpful!!

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Specializes in Biological Sciences.

Some of the differences:

  • G tube is more comfortable
  • G tube can easily be changed at home
  • G tube is not open, no one came to know either the child or patient is being fed by tube.
  • G tube can easily be vented out to release gas from the stomach as compared to J tube
  • J tube has more leakage problems as compare to G tube
  • J tubes need the G tube for the vent
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