This information will prepare you for your procedure to have a percutaneous endoscopic gastrostomy (PEG) or a percutaneous endoscopic jejunostomy (PEJ) placed at Memorial Sloan Kettering Cancer Center (MSKCC). A PEG is a feeding tube that is placed in your stomach. If the tube can't be placed in your stomach, you may have a percutaneous endoscopic jejunostomy (PEJ) placed instead. In this case, the tube is placed in your jejunum, which is the first part of your small intestine. A feeding tube is placed if you are not able to eat enough food. If you are able to eat, you may continue to do so after the PEG or PEJ is inserted. You will use the tube to give yourself enough extra nutrition to meet your needs. The tube is placed during a procedure called an endoscopy.
A Week Before Your Procedure
Ask about your medications
You may need to stop taking some of your medication before your procedure. We have included some common examples below.
- If you take medication to thin your blood, ask the doctor who prescribes it for you when to stop taking it. Some examples are warfarin (Coumadin®), dalteparin (Fragmin®), heparin, tinzaparin (Innophep®), enoxaparin (Lovenox®), clopidogrel (Plavix®), and cilostazol (Pletal®).
- If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medicine what you should do the morning of your procedure.
Get a letter from your doctor, if necessary
If you have an automatic implantable cardioverter-defibrillator (AICD), you will need to get a clearance letter from your cardiologist before your procedure.
Arrange for someone to take you home
You must have someone 18 years or older take you home after your procedure. Please call one of the agencies below if you do not have someone who can do this. They will help find someone to take you home.
Partners in Care (888) 735-8913
Caring People (877) 227-4649
3 Days Before Your Procedure
You will receive a telephone call from an endoscopy nurse. He or she will review the instructions in this guide with you and ask you questions about your medical history. The nurse will also review your medications and tell you which to take the morning of your procedure. Use the space below to write them down.
The Day Before Your Procedure
A clerk from the Admitting Office will call you after 2:00 pm the day before your procedure. He or she will tell you what time you should arrive at the hospital for your procedure. If you are scheduled for your procedure on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call (212) 639-5014.
If you need to cancel your procedure for any reason please call the doctor who scheduled it for you.
Do not eat or drink anything after midnight the night before your surgery. This includes water, gum, and hard candy.
The Day of Your Procedure
Things to remember
- Do not eat or drink anything the morning of your surgery. This includes water, gum, and hard candy.
- Take only the medicines your doctor told you to take the morning of your procedure. You may have written them down on the first page of this guide. Take them with a few sips of water.
- Do not put on any lotion, cream, powder, deodorant, make-up, or perfume.
- Remove jewelry, including body piercings.
- Leave all valuables such as credit cards and jewelry at home.
- If you wear contacts wear your glasses instead.
What to bring with you
- A list of the medications you take at home
- Medications for breathing problems (such as inhalers), medicines for chest pain, or both
- A case for your glasses
- Your Health Care Proxy form, if you have completed one
Where to Park
Parking at MSKCC is available in the garage on East 66th Street between York and First Avenues. To reach the garage, enter East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a tunnel that goes from the garage into the hospital. There are also commercial garages nearby: 4 on East 69th Street between First and Second Avenues and 3 on East 65th Street between First and Second Avenues. For questions about prices, call (212) 639-2338.
Where to go
Please arrive at the Surgical Day Hospital (SDH) at 1275 York Avenue. This is the main building of MSKCC. Take the M elevator to the 2nd floor.
What to expect
Once you arrive at the hospital, doctors, nurses, and other staff members will ask you to state and spell your name and date of birth many times. This is for your safety. Patients with the same or similar names may be having procedures on the same day.
Your doctor will explain the procedure to you and answer any questions you may have. He or she will ask you to sign a consent form.
When it's time for your procedure, you will be brought into the procedure room and helped onto an exam table. You will be attached to equipment to monitor your heart, breathing, and blood pressure. You will also receive oxygen through your nose. A mouth guard will be placed over your teeth to protect them.
You will receive anesthesia through your IV, which will make you fall asleep. Once you are asleep, your doctor will pass the endoscope through your mouth, down your esophagus (food pipe), into your stomach, and into the first part of your small intestine.
A tiny incision (surgical cut) will be made on the skin of your abdominal wall and a feeding tube will be passed through your incision. The feeding tube will extend 8 to 12 inches outside your body and will be covered by a small bandage to keep it in place. When the doctor has completed the procedure, the endoscope will slowly be taken out.
After Your Procedure
You will be taken to the Post Anesthesia Care Unit (PACU), where a nurse will monitor your temperature, pulse, breathing, and blood pressure. He or she will also check the bandage around your tube. You will stay in the PACU until you are fully awake.
When you are fully awake, the nutrition nurse will show you and your caregiver how to use the feeding tube, how to handle the PEG or PEJ, and how to give yourself the feeding solutions. It is very important to have your caregiver with you during the teaching session.
You will be given supplies before you leave the hospital.
You may feel some soreness in your throat. This is normal and will get better in a day or two.
You may have some discomfort at your incision site for the first 24 to 48 hours. If needed, you will be prescribed pain medication for discomfort. Use the medication as instructed.
You may shower 48 hours after your procedure. Do not take tub baths or go swimming for 1 week after your procedure.
Caring for the Skin Around Your PEG or PEJ
- Inspect the skin around your feeding tube daily for any redness, swelling, or pus. Tell your doctor if you are having any of these symptoms.
- Clean your skin around the tube with iodine (Betadine®) swab sticks once a day for 2 days. Loop the tube, cover it with a dry, sterile bandage, and secure it with tape or use a Cath-Secure® tab to hold the tube in place.
- On the third day after your procedure, begin a daily routine of caring for the skin around your tube while showering. Wash it with a mild soap such as Dove® or Neutrogena® and water. Dry your skin well, cover it with a bandage, loop the tube, and secure it with tape or with a Cath-Secure® tab.
Your nutritionist will give you the Oley Complication Chart to help you manage any major side effects you might have with tube feeding. To view the chart online, go to http://www.oley.org/charts/newHEN.pdf
Call Your Doctor or Nurse Immediately if You Develop
- Chest pain or shortness of breath
- Severe abdominal pain, hardness, or swelling
- Vomiting blood
- A temperature of 101° F (38.3° C) or higher
- Weakness, faintness, or both
- Any sign of bleeding
- Pain at your incision site that does not get better with the medication you were prescribed
- Any sign of redness, swelling, or discharge around the tube