There seem to be two ways to get a PEG.

One is by a Gastro-Doc, using a mild sedation so you don't recall any of it -- He/she puts an endoscope down your throat to the stomach to get the right spot and then cuts in from outside to install the PEG through the abdominal wall and stomach wall -- I've had two that way and apart from some mild discomfort at first, they didn't bother me after a few days. Usually you get a bigger PEG (20 French) that way, easier to maintain and less likely to clog.

Some people have reported more pain afterwards.

The second way is by a radiologist using a fluoroscope and local anesthesia to cut hole and guide tube down inside. Usually used after surgery when damage to throat is enough that they don't want to use an endoscope. Also results in smaller PEG (12-14 French), more like to clog and be a problem. I have had one that way.

Having had one of each, I chose to have the larger PEG third time around, done before the cancer surgery -- That meant that not only did I have the bigger PEG, I also didn't need the Naso-Gastric Tube during and after surgery, so things were a lot more pleasant my first few days after (My first NGT was fastened to my septum with three stitches and didn't work right -- Every time someone bumped it, it hurt, and then they had to replace it; finally putting in the skinny PEG).