Gastrostomy tubes: Placement and routine care
- Mark H DeLegge, MD, FACG, AGAF
Mark H DeLegge, MD, FACG, AGAF
- Professor of Medicine
- Medical University of South Carolina
- Section Editors
- John R Saltzman, MD, FACP, FACG, FASGE, AGAF
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
- Section Editor — Therapeutic and Diagnostic Endoscopy
- Professor of Medicine
- Harvard Medical School
- Timothy O Lipman, MD
Timothy O Lipman, MD
- Section Editor — Nutrition
- GI-Hepatology-Nutrition Section
- Washington DC Veterans Affairs Medical Center
Gastrostomy tubes may be placed endoscopically, surgically, or radiologically.
This topic will review the placement and routine care of gastrostomy tubes, including management of dysfunctioning gastrostomy tubes, with a focus on percutaneous endoscopic gastrostomy tubes. The indications for gastrostomy tube placement and complications associated with gastrostomy tubes are discussed separately. (See "Gastrostomy tubes: Uses, patient selection, and efficacy in adults" and "Gastrostomy tubes: Complications and their management".)
Options for gastrostomy tube placement — Gastrostomy tubes may be placed endoscopically, surgically, or by radiologically. The choice of procedure will depend on local resources and expertise, anatomic considerations that may affect the ability to place the tube endoscopically or radiologically (eg, inability to endoscopically identify an appropriate placement site because of prior surgery or obesity), and whether the patient is undergoing surgery for other reasons .
Studies comparing surgical gastrostomy with percutaneous endoscopic gastrostomy (PEG) have shown no difference in morbidity or mortality . However, PEG is less expensive and saves time. Thus, surgical gastrostomy is typically reserved for patients who are already going to the operating room for another surgical procedure. Surgical gastrostomy may also be considered for patients in whom a gastrostomy tube cannot be placed either endoscopically or radiologically. Reasons a gastrostomy tube may not be able to be placed endoscopically or radiologically include esophageal obstruction (because placement requires passage of the tube through the esophagus) or the presence of an anatomic aberration that prevents a safe percutaneous approach for PEG tube placement (eg, colonic interposition between the stomach and the abdominal wall).
Whether there is a difference in morbidity and mortality between endoscopic and radiologic gastrostomy tube placement is not clear [3-8].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- TECHNICAL CONSIDERATIONS
- Options for gastrostomy tube placement
- Techniques for gastrostomy tube placement
- - Endoscopic placement
- - Radiologic placement
- - Surgical placement
- Proper placement of the external bolster
- Special settings
- - Gastric varices
- - Prior abdominal surgery
- - Obesity
- - Pregnancy
- - Ascites
- TYPES OF GASTROSTOMY TUBES
- Endoscopically- and radiologically-placed tubes
- Surgically-placed tubes
- Replacement tubes
- INITIATION OF TUBE FEEDS
- GASTROSTOMY TUBE CARE
- Routine care
- Gastrostomy tube removal
- Managing dysfunctioning gastrostomy tubes
- - Clogging
- - Tube deterioration
- - Early balloon deflation
- Managing complications of tube feeds
- SUMMARY AND RECOMMENDATIONS