Gastrostomy Tube Placement

A gastrostomy tube placement (also called a G-tube) is a surgical procedure in which a feeding tube is inserted through a small incision in the abdomen to deliver nutrition directly into the stomach in patients either unable to feed themselves, or who are unable to obtain sufficient nutrients orally due to certain illnesses.

Indications

Your physician may recommend a gastrostomy tube placement for feeding and nutritional support, hydration, or delivering medications in patients who have issues that prevent them from receiving adequate nutrition. These issues include:

• Congenital defects of the mouth, esophagus, intestines, or stomach
• Failure to thrive (occurs when a child cannot gain weight and grow normally)
• Swallowing disorders
• Neurological disorders, such as dementia or Parkinson’s disease that can make chewing or swallowing difficult
• Stroke or other brain injuries
• Surgery of the head and neck
• Oropharyngeal and esophageal problems or tumors

Preparation

Preparation for gastrostomy tube placement surgery may involve the following steps:

• A thorough history and physical examination
• Routine blood work and imaging such as X-ray of the upper gastrointestinal (GI) system
• Informing your doctor of any medications or supplements you are taking
• Refraining from certain medications such as blood thinners, which may affect blood clotting
• Informing your doctor of any allergies to medications, anesthesia, or latex
• Disclosing any recent illnesses or other medical conditions you have
• Refraining from solids or liquids at least 8 hours prior to the procedure
• Arranging for someone to drive you home after the procedure
• Signing an informed consent form

Surgical procedure

Gastrostomy tube placement can be performed using two methods: as a percutaneous endoscopic gastrostomy (PEG), and as an open surgical procedure.

PEG Procedure

PEG is the most common method to place a gastrostomy tube and is much less invasive than open abdominal surgery. Percutaneous means through the skin, while endoscopic refers to an internal examination with a tube.

In general the PEG procedure involves the following steps:

• You will receive an intravenous sedative and antibiotic, as well as a local anesthestic, prior to the procedure.
• Your physician inserts an endoscope through your mouth and advances it down the esophagus to the stomach. An endoscope is a long, thin, flexible tube with a light and a camera at the end which helps your surgeon see internal structures clearly in order to guide the G-tube into place.
• With the help of the endoscope, the exact site of the PEG tube is determined, and the skin over the left side of the abdomen area is cleaned and numbed.
• A small incision is made in this area, and the G-tube is passed through into the stomach. The G-tube is small, flexible, and hollow.
• Finally, the scope and instruments are withdrawn, and stitches are used to close the stomach around the tube.

Open Abdominal Surgery

A gastrostomy tube placement is usually not carried out using an open surgical approach, unless the patient cannot tolerate an endoscope insertion, is having other stomach surgery, or if there is scar tissue from a previous surgery.

Open abdominal surgery is performed under general anesthesia. The skin over the stomach area is cleaned with an antiseptic solution. Your surgeon makes an initial incision through the skin and the abdominal wall, and once inside the body, another incision is made into the stomach, called a stoma. A gastrostomy tube is then guided into the stomach and is stitched into place. Your surgeon then closes the incision.

Postoperative care

Following surgery, you will be transferred to the recovery area for observation. A postoperative dressing will be placed over the site of the tube placement. You may have minor pain and soreness at the incision site, which can be managed with medications. Feedings will start slowly with clear liquids and be advanced accordingly. A follow-up appointment will be scheduled to monitor your progress. Prior to discharge, you will be provided with a series of instructions on how to care for your gastrostomy tube. These include the following:

• What to do if the tube is pulled out
• How to care for the skin around the tube
• How and what to feed through the tube
• How to empty the stomach through the tube
• Signs and symptoms of tube blockage
• Signs and symptoms of infection
• Which normal activities can be continued

Risks and Complications

The risks and complications associated with a gastrostomy tube placement can include:

• Infection
• Pain
• Aspiration (accidental inhalation of stomach contents into the lungs)
• Tube dislodgement
• Bleeding and perforation
• Leakage around the tube

Summary

A gastrostomy tube placement is a safe and effective method of feeding and providing nutritional support for patients who are unable to get sufficient nutrition by mouth. The entire procedure takes about 30 to 45 minutes, and you may return home the same day or the next morning. The feeding tube requires regular cleaning and drying. Contact your health care provider for any questions regarding the maintenance and performance of your gastrostomy tube or G-tube.