Gastrostomy tubes: Uses, patient selection, and efficacy in adults
- 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
No disease process improves significantly with starvation, but providing nutrition can be a challenge in patients who cannot or will not eat. Failure of enteral supplements, dietary counseling, and appetite stimulation frequently leads to a decision about the use of tube feeding .
Enteral access must be obtained for tube feeding to begin. Temporary access can be achieved with a nasogastric or nasoenteric feeding tube. These tubes are easily placed at the bedside and can also be easily removed. Unfortunately, they often fail secondary to clogging or inadvertent dislodgement, and do not provide a secure access route for the provision of nutrition, medications, or fluids . More permanent enteral access can be obtained either endoscopically, surgically, or with interventional radiology, resulting in either a gastrostomy or jejunostomy. Percutaneous endoscopic gastrostomy (PEG) tube placement has developed into a common procedure to obtain gastric access. The development of the PEG procedure and standardized PEG kits was an important technological advance in the enteral access field.
This topic will review conditions for which gastrostomy tubes are placed, the selection of patients for gastrostomy tube placement, and the available evidence on effectiveness of gastrostomy tubes. The placement, care, and complications of endoscopically placed gastrostomy tubes are discussed separately. (See "Gastrostomy tubes: Placement and routine care" and "Gastrostomy tubes: Complications and their management".)
CONDITIONS FOR WHICH GASTROSTOMY TUBES ARE USED
Percutaneous endoscopic gastrostomy (PEG) tubes are placed for a variety of conditions that interfere with a patient's oral intake. Commonly, PEG tubes are used to provide a route for enteral feeding, hydration, and medication administration in patients who are likely to have prolonged inadequate or absent oral intake. The decision to place a gastrostomy tube in a given patient must take into account the indication for the gastrostomy tube, the patient's prognosis, the goals of treatment, and the patient and family's beliefs and desires. (See 'Patient selection' below.)
Gastrostomy tubes are often placed in patients with :
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- CONDITIONS FOR WHICH GASTROSTOMY TUBES ARE USED
- PATIENT SELECTION
- Mixed patient populations
- - Survival
- - Functional and nutritional status
- - Quality of life
- Patients in long-term care facilities
- - Nutritional status and survival
- - Functional status and quality of life
- - Pressure ulcers
- Patients with neurologic disorders
- - Stroke, brain injury, or neurodegenerative disease
- - Dementia
- Patients with cancer
- Patients at risk for aspiration
- - Comparison of gastrostomy tubes with nasogastric tubes
- - Pre- versus post-pyloric feeding
- SUMMARY AND RECOMMENDATIONS