Medical Oncologist
CION Cancer Clinics
PEG, RIG or surgical gastrostomy: what is the difference? | CION Cancer Clinics
All three place the same feeding tube through the belly wall into the stomach. A PEG uses a camera passed down the throat to guide it, a RIG uses X-ray pictures, and a surgical gastrostomy is made through a cut by a surgeon. Which one you are offered depends on where the cancer sits, how fit you are for sedation, and what your centre does most. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is the difference between PEG, RIG and surgical gastrostomy?
- How each method actually gets the tube in
- PEG and RIG, compared
- What the team weighs before picking a route
- Four things families ask us, and what is actually true
- What this comparison cannot tell you
- Common questions about PEG, RIG and surgical tubes
The short answer
What is the difference between PEG, RIG and surgical gastrostomy?
All three put the same kind of feeding tube through the belly wall into the stomach. The difference is how the doctor sees where to make the opening: a camera down the throat for a PEG, X-ray pictures for a RIG, and a direct view through a cut for a surgical gastrostomy.
Why the route matters to you
The route decides who does the procedure, what kind of sedation or anaesthetic is used, how long you stay in hospital, and whether it can be done at all when a tumour is blocking the throat. Once the tube is in and the site has healed, feeding and daily care are almost the same whichever route was used.
Who chooses, and on what basis
Your treating team chooses, usually a surgical oncologist together with a gastroenterologist or a radiologist. They look at where the cancer is, whether a camera can pass safely, how fit you are for sedation, whether you are already due an operation, and what the local unit has most experience with. The right question to ask is not "which is the superior method" but "why this one for me".
Whichever route is planned, ask who will look after the tube afterwards and who the family should call at home.One tube, three routes
How each method actually gets the tube in
What is done, who does it, and the situation each one tends to be chosen for.
PEG: with a camera
A gastroenterologist passes a thin camera down the throat into the stomach and fills it with air. A light on the camera shows through the belly wall, marking the spot. A needle and guide wire go in from outside, and the tube is pulled into place. Done under sedation with local anaesthetic in the skin.
Usually chosen when
- The throat is open enough for the camera
- Feeding is likely to be needed for weeks or more
RIG: with X-ray
A radiologist passes a fine tube through the nose to put air into the stomach, then uses live X-ray to see it. The belly wall is numbed, the stomach is stitched up to the wall with tiny anchors, and the tube is placed through the skin. No camera goes down the throat.
Usually chosen when
- A tumour narrows the throat or food pipe
- Sedation for a camera test is a worry
Surgical: through a cut
A surgeon opens the belly, either with one cut or by keyhole, and stitches the stomach to the belly wall around the tube. It needs a general anaesthetic and an operating theatre, so it is mostly done when you are already having an operation, or when the other two routes cannot be used.
Usually chosen when
- Another abdominal operation is planned anyway
- Scarring or anatomy rules out PEG and RIG
Side by side
PEG and RIG, compared
PEG (camera)
RIG (X-ray)
Camera passed down the throat
Fine tube through the nose, no camera
Sedation plus local anaesthetic
Local anaesthetic, sometimes light sedation
Not possible if the throat is too narrow
Possible with a narrowed throat
Held in by an internal disc; harder to pull out by accident
Often a balloon tube; easier to dislodge, easier to swap
Done by a gastroenterologist in an endoscopy room
Done by a radiologist in an X-ray suite
Not sure whether this applies to you?
Ask an oncologistHow the choice is made
What the team weighs before picking a route
Can a camera pass?
If a mouth, throat or food-pipe cancer leaves too little room, a PEG is off the table and the team looks at RIG. If the camera can pass safely, PEG is usually the first choice because it is quick and familiar.
How fit are you for sedation?
Heart and lung problems, or a very frail patient, push the team towards the route with the lightest sedation. This is one reason RIG is chosen for some older patients.
Is an operation already planned?
If you are having belly surgery for the cancer anyway, the surgeon can add a gastrostomy during the same anaesthetic rather than book a separate procedure later.
What is available locally?
Not every hospital has interventional radiology, and units are safest doing what they do often. Ask your centre which routes it offers and which it does most.
Commonly believed
Four things families ask us, and what is actually true
"Surgical is the proper one; the others are shortcuts."
The opposite is closer to the truth. PEG and RIG were developed so that people would not need a general anaesthetic and an operation just to be fed. Surgical placement is now kept for the cases where the simpler routes cannot be used.
"A RIG is a lesser tube."
It is the same opening and does the same job. RIG tubes are often the balloon type, which can be changed at the bedside without a camera. That is a practical difference, not a lower grade of treatment.
"The camera will spread the throat cancer to the stomach."
Seeding of cancer cells along the tube track has been reported, but it is rare. Where a tumour sits right in the camera's path, the team may prefer a RIG partly for this reason. It is a question worth asking, not a reason to refuse the tube.
"You cannot have a PEG if you have had belly surgery before."
Previous surgery makes the team look harder at where the bowel and stomach now sit, and sometimes a scan is done first. It does not rule a PEG out on its own. It can make a surgical route the safer option in some people.
Did you know
Some centres place a tube before radiotherapy to the head and neck even begins, so that it is healed and ready by the time swallowing becomes sore. Others wait and place it only if needed. Both are accepted approaches, and your team will tell you which it follows.
Being straight with you
What this comparison cannot tell you
It cannot tell you which route you should have. That depends on your cancer, your scans, your fitness for sedation, and what your centre does well. A page that ranks the three methods for everyone would be wrong for many readers.
Who none of these routes suits
If the stomach has been removed or is diseased, a tube into the small bowel is used instead. If feeding is only needed for a short spell, a nose tube may do the job without any opening in the skin. And if a person is very unwell and near the end of life, a tube by any route does not always help, and that conversation should be gentle and led by what the person would want.
Questions to take to the appointment
Which route is planned and why that one for me? Who will do it, and how many does the unit do? What sedation will be used? How long will I stay? What type of tube will be left in, and how is it changed? Who do we call at home? Write the answers down. If you would like a second opinion on the route, that is a normal request and no one will mind.
CION does not promise any particular route. Ask the centre placing the tube which methods it offers.Questions we are asked
Common questions about PEG, RIG and surgical tubes
Is PEG or RIG safer?
Both are considered safe when done by a unit that does them regularly, and neither is safer for everyone. The problems that can happen are similar: infection at the site, leaking, the tube coming out, and rarely bleeding or injury to the bowel. The safer one for you is the one that fits your throat, your fitness and your centre's experience.
Which one hurts less?
The site is sore for a few days after any of the three, because there is a fresh opening in the belly wall. Surgical placement usually means a larger cut and a longer recovery. PEG and RIG are broadly similar in soreness. Simple pain relief prescribed by the team settles it for most people.
Why was my mother offered a RIG rather than a PEG?
Most often because the camera could not pass safely, or because the team wanted to avoid deeper sedation. Sometimes it is simply the route that centre does most. Ask the team directly; there is always a reason, and it is usually a good one.
Do I stay in hospital longer for one of them?
PEG and RIG are usually a short stay, often a night, so the first feeds can be watched. A surgical gastrostomy done on its own means a general anaesthetic and a longer stay; done during another operation, the stay is set by the bigger procedure. Your team will tell you what to expect.
Can a PEG be changed to a RIG later, or the other way round?
The opening is the same, so once the track has healed, the tube in it can be changed for a different type, including a balloon tube or a low-profile button. This is done through the existing opening without a new procedure of either kind.
Does it matter for feeding at home?
Very little. Flushing, feeding, giving medicines and cleaning the site are the same. The one practical difference is the fixing: balloon tubes need the balloon water checked on a schedule, and disc tubes do not. The nurse will show you what your tube needs.
Are all three covered by Aarogyasri or insurance?
When placed as part of an approved cancer treatment plan, all three are often covered. Aarogyasri, CGHS, ECHS and EHS are accepted at CION, and most cashless insurers are empanelled. Feed and supplies at home are a separate cost, so ask about both.
What should I bring to the appointment?
Every scan and report, the list of current medicines including blood thinners, and the family member who will do the feeding at home. Tell the team about any previous belly surgery and any heart or lung problems, because these change which route is chosen.
Meet the Specialists
17+ senior cancer specialists. One panel for your case.
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Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
Surgical Oncologist
Radiation Oncologist
Radiation Oncologist
Radiation Oncologist
Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
Surgical Oncologist
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Sources
- NHS — Gastroscopy
- Cancer Research UK — Diet problems with cancer
- National Cancer Institute — Nutrition in Cancer Care (PDQ) - Patient Version
- NICE — Nutrition support for adults (CG32)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Gastrostomy: what a feeding tube into the stomach isStart here if the word itself is newHaving a feeding tube placed: what happensThe day itself, step by stepWho needs a feeding tube during cancer treatmentThe situations where a tube is usually suggestedAnaesthesia for cancer surgerySedation and general anaesthetic explainedChoosing a surgeon and a centreWhat to ask about a unit's experience
Talk to us
Not sure why one route was chosen?
Call the helpline or send us the letter. A surgical oncologist will explain what the team weighed and what to ask before the tube is placed.