From the Guidelines
The primary distinction between a Nasogastric (NG) tube and a Percutaneous Endoscopic Gastrostomy (PEG) tube lies in their placement method and intended duration of use, with NG tubes suitable for short-term feeding and PEG tubes preferred for long-term nutritional support.
Key Differences
- An NG tube is inserted through the nose, down the esophagus, and into the stomach, making it suitable for short-term feeding and medication administration, typically for a few weeks 1.
- A PEG tube is surgically inserted directly through the abdominal wall into the stomach, making it appropriate for long-term nutritional support (months to years) 1.
Placement and Duration
- For short-term enteral access (less than 4 weeks), flexible tube placement via the nasal route is preferred 1.
- Percutaneous tube placement is typically reserved for individuals who are expected to require enteral access for 4 or more weeks 1.
Patient Comfort and Complications
- NG tubes can cause nasal irritation, discomfort, and are more visible, while PEG tubes are more comfortable for extended use, less visible under clothing, and have a lower risk of displacement 1.
- However, PEG tubes require a surgical procedure for placement and removal, which may add risk 1.
Clinical Decision Making
- The choice between these tubes depends on the anticipated duration of enteral feeding needs, with NG tubes preferred for temporary situations and PEG tubes for patients requiring prolonged nutritional support 1.
- In nonintubated patients, flexible tube placement via the nasal route is preferred for short-term enteral access, while percutaneous tube placement is reserved for long-term access 1.
From the Research
Comparison of Nasogastric (NG) and Percutaneous Endoscopic Gastrostomy (PEG) Tubes
- The main difference between NG and PEG tubes is the method of insertion and the duration of use. NG tubes are inserted through the nose and into the stomach, while PEG tubes are inserted directly into the stomach through the abdominal wall 2, 3, 4, 5, 6.
- PEG tubes are generally considered superior to NG tubes for long-term enteral feeding, as they are more comfortable for patients, have a lower risk of aspiration and self-extubation, and are associated with improved survival 2, 3, 6.
- NG tubes are often used for short-term enteral feeding, while PEG tubes are used for longer-term feeding, typically more than 3-4 weeks 4, 5.
- The European Society for Clinical Nutrition and Metabolism recommends PEG tubes when enteral nutrition is expected to last more than 3 weeks 4.
- PEG tubes have a lower rate of feeding tube dislodgement and are associated with a lower incidence of aspiration pneumonia, but may have a higher risk of complications such as wound infection, bleeding, and buried bumper syndrome 3, 4, 6.
Indications and Contraindications
- PEG tubes are indicated for patients with insufficient oral intake who need enteral feeding or therapeutic gastric decompression, while NG tubes are often used for patients with acute medical conditions or those who require short-term enteral feeding 2, 3, 5.
- The decision to use a PEG or NG tube should be based on the individual patient's needs and medical condition, as well as the expected duration of enteral feeding 4, 5.
Complications and Management
- Both PEG and NG tubes can have complications, including aspiration, self-extubation, and infection 2, 3, 6.
- PEG tubes may have additional complications, such as buried bumper syndrome, colocutaneous fistula, and perforation 3.
- Proper patient selection, insertion technique, and management of complications are important for patient care and outcomes 3, 5.