When should a percutaneous endoscopic gastrostomy (PEG) tube be changed?

When to Change a PEG Tube

PEG tubes do not require routine scheduled replacement and should only be changed when specific complications occur, such as tube breakage, occlusion, dislodgement, or material degradation. 1

No Routine Replacement Needed

• Most transorally placed bumper-type PEG tubes can be maintained for many years with proper care and handling 1
• The durability of a PEG system is primarily linked to careful handling rather than time in place 1
• There is no need to exchange a tube system at regular intervals 1

Specific Indications for PEG Tube Replacement

Replace the PEG tube only when:

• Tube breakage occurs 1
• Tube occlusion develops that cannot be cleared 1
• Tube dislodgement happens 1
• Material degradation with compromised structural integrity is evident 1
• Fungal colonization with material deterioration is present 1
• Persistent peristomal infection that does not resolve despite appropriate antimicrobial treatment 1
• Stoma tract disruption occurs 1
• Severe skin excoriation develops at the site 1

Important Timing Considerations

For Initial Button Conversion

• If converting from a standard PEG to a low-profile button (Mic-Key), wait at least 4 weeks after initial gastrostomy placement to allow complete stoma tract maturation 2
• The gastrocutaneous tract typically adheres within 7-14 days but requires 4-6 weeks for complete maturation 2, 3

For Balloon-Type Replacement Tubes

• Balloon-type replacement tubes (not the original PEG) require replacement approximately every 3-4 months due to balloon degradation 2, 4
• Check balloon water volume weekly to prevent spontaneous deflation 2

For Button Systems

• Button systems require routine replacement approximately every 6 months due to material fatigue 4

Critical Safety Principles for PEG Replacement

When replacement is necessary, follow these three principles to prevent serious complications like peritonitis:

1. Ensure good control of the replacement tube along the well-formed gastrocutaneous tract 3
2. Use minimal insertion force during replacement 3
3. Confirm intragastric placement with reliable methods (water-soluble contrast study if any difficulty occurs) 2, 3

Common Pitfalls to Avoid

• Never attempt blind replacement before 4 weeks after initial placement—this is an emergency requiring endoscopic or radiologic guidance 2, 5
• The PEG tract is more friable than surgical gastrostomy because there is no suture fixation between gastric and abdominal wall 3
• Patients with malnutrition, diabetes, ascites, or immunosuppression may have delayed tract maturation beyond 4-6 weeks 2, 3
• If any difficulty occurs during replacement, confirm position before use to rule out intraperitoneal placement 2, 3

Removal Technique for Bumper-Type Tubes

• Use the "cut and push" technique: cut the tube at abdominal skin level and push the internal bumper into the intestinal lumen 1
• Migration is usually uneventful even with large-caliber tubes 1
• Consider endoscopic retrieval in patients with previous bowel surgery or at risk of strictures/ileus 1