How risky is a PEG?
Percutaneous endoscopic gastrostomy (PEG) is a method of medical nutrition that has been established in Germany since the 1980s.
Overall, a PEG is associated with lower risks. Only in very rare cases can wound infections or inflammation in the abdominal cavity occur. The feeding tube itself and the “retention plate” located in the abdominal wall are made of plastic and can last for years. Despite their durability and decades of use, material fatigue may occur in isolated cases, necessitating replacement of the material.
The surgical procedure for PEG placement has also been established for decades and is a common procedure offered and performed at numerous hospitals. Overall, the surgical risks are considered low. The risks increase if significant weight loss (more than 10% of the initial weight) has already occurred prior to PEG placement (e.g., due to a delay in deciding to undergo PEG placement).
Placing a PEG tube can also become more difficult if respiratory dysfunction is present. In this scenario, there is a risk that ALS-related respiratory weakness will be exacerbated by the brief anesthesia required for PEG placement, potentially necessitating mechanical ventilation. To minimize this risk, a PEG tube should be placed as early as possible and before respiratory dysfunction sets in. If early PEG placement is not possible and respiratory function is already impaired, the risk of additional respiratory failure (exacerbated by anesthesia) should be discussed prior to the PEG placement procedure, and the possibility of respiratory support during the procedure should be agreed upon.
In rare cases, ventilator therapy that became necessary during PEG placement must be continued even after discharge from the hospital. This possibility is also one of the indirect risks associated with PEG tube placement. For example, complications involving bleeding in the surgical site may occur during the surgical procedure to place the PEG tube.
Other risks include peritonitis, which may require several days of follow-up treatment and a prolonged hospital stay. In the days following PEG placement, symptoms may occur that are related to the initial use of the feeding tube. For example, administering larger volumes of the feeding solution can lead to significant and unfamiliar stomach distension. This sensation of a full stomach (“stomach balloon”) can slightly restrict diaphragmatic movement. In cases of severe respiratory dysfunction, the PEG-induced elevation of the stomach can lead to increased respiratory effort.
Following PEG placement, dietary intake should therefore be increased gradually, particularly in cases of respiratory dysfunction. It is recommended to involve a nutrition team with experience in ALS. Despite the numerous risks mentioned—which are rare overall and occur only under specific circumstances—PEG placement and PEG-based feeding are considered safe and well-established methods of nutritional therapy.