Gastrostomy vs PEG Tube: Key Differences
A PEG (percutaneous endoscopic gastrostomy) tube is a specific type of gastrostomy tube—the term "gastrostomy" refers to any feeding tube placed through the abdominal wall into the stomach, while PEG specifically describes the endoscopic insertion method, which is the preferred technique for long-term enteral nutrition. 1
Understanding the Terminology
Gastrostomy is the general term for any tube providing access to the stomach through the abdominal wall, and can be placed by three different methods 1:
- Endoscopic placement (PEG) - inserted using an endoscope under sedation 1
- Surgical placement - inserted via open surgery (Stamm or Janeway techniques) or laparoscopic surgery (PLAG) 1
- Radiological placement (PRG/RIG) - inserted under fluoroscopic guidance 1
PEG specifically refers to the percutaneous endoscopic gastrostomy technique, which has become the standard of care 1.
Why PEG is the Preferred Gastrostomy Method
For long-term enteral nutrition (>6 weeks), PEG should be your first-line choice over surgical gastrostomy due to superior outcomes across multiple domains 1:
- Lower complication rates - PEG demonstrates significantly fewer major complications compared to surgical gastrostomy 1, 2
- Reduced mortality risk - PEG is associated with lower 30-day mortality compared to both radiological and surgical approaches 1, 2
- Cost-effectiveness - PEG has lower procedural costs than surgical alternatives 1
- Shorter procedure time - PEG insertion averages 30 minutes versus 68 minutes for open surgical gastrostomy 3
- Better patient tolerance - PEG offers superior quality of life, fewer intervention failures (tube blocking, leakage, dislodgement), and better nutritional outcomes compared to nasogastric tubes 1, 4
The ESPEN guidelines provide a Grade B recommendation with 93% consensus supporting PEG as the preferred gastrostomy technique 1.
When PEG Cannot Be Used
If endoscopic placement is contraindicated or fails, use this algorithm 1:
First alternative: Percutaneous Laparoscopic Assisted Gastrostomy (PLAG) - demonstrates the lowest complication rate among all gastrostomy techniques in comparative studies 1
Second alternative: Radiological gastrostomy (PRG/RIG) - reserved for patients where endoscopic technique is impossible, though associated with higher tube dislodgement rates and increased 30-day mortality compared to PEG 1, 2
Last resort: Open surgical gastrostomy - has the highest complication rates including 6.65 times higher risk of colon perforation compared to PEG 2
Important Clinical Caveats
Absolute contraindications to PEG placement include 5, 6:
PEG failure rates occur in approximately 10% of attempts, with technical difficulties in another 6% of cases 7. When PEG placement fails, proceed immediately to PLAG rather than attempting radiological placement 1.
For patients with specific gastric complications, consider jejunal feeding alternatives 1, 8:
- Gastroduodenal motility disorders → PEJ or PEG/J 1, 8
- Gastric outlet stenosis → PEJ or PEG/J 1, 8
- High aspiration risk → Direct PEJ preferred over PEG/J due to lower tube dysfunction rates 8
Infection prevention is critical - prophylactic antibiotics and proper exit site care during the first 5-7 days post-procedure significantly reduce wound infections 4, 6.