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Gastrostomy tubes: Placement and routine care

Mark H DeLegge, MD, FACG, AGAF
Section Editors
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Timothy O Lipman, MD
Deputy Editor
Kristen M Robson, MD, MBA, FACG


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 [1].

Studies comparing surgical gastrostomy with percutaneous endoscopic gastrostomy (PEG) have shown no difference in morbidity or mortality [2]. 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].

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Literature review current through: Dec 2017. | This topic last updated: Aug 11, 2016.
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