Feeding tube insertion - gastrostomy

Gastrostomy tube insertion; G-tube insertion; PEG tube insertion; Stomach tube insertion; Percutaneous endoscopic gastrostomy tube insertion

A gastrostomy feeding tube (G-tube) insertion is the placement of a feeding tube through the skin and the stomach wall. It goes directly into the stomach.

Description

Gastrostomy feeding tube insertion is done in part using a procedure called endoscopy. This is a way of looking inside the body using a flexible tube with a small camera on the end of it. The endoscope is inserted through the mouth and down the esophagus, which leads to the stomach.

After the endoscopy tube is inserted into the stomach, the skin over the left side of the belly (abdomen) area is cleaned and numbed. Your surgeon makes a small surgical cut in this area. The G-tube is inserted through this cut into the stomach. The tube is small, flexible, and hollow. Your surgeon uses stitches to close the stomach around the tube.

Why the Procedure Is Performed

Gastrostomy feeding tubes are put in for different reasons. They may be needed for a short time or permanently. This procedure may be used for:

Babies with birth defects of the mouth, esophagus, or stomach (for example, esophageal atresia or tracheal esophageal fistula)
Esophageal atresia
Esophageal atresia is a birth defect in which the esophagus does not develop properly. The esophagus is the tube that normally carries food from the...

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Fistula
A fistula is an abnormal connection between two body parts, such as an organ or blood vessel and another structure. Fistulas are usually the result ...
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People who cannot swallow correctly
People who cannot take enough food by mouth to stay healthy
People who often breathe in food when eating

Risks

Risks for surgical or endoscopic feeding tube insertion are:

Bleeding
Infection

Before the Procedure

You will be given a sedative and a painkiller. In most cases, these medicines are given through a vein (IV line) in your arm. You should feel no pain and not remember the procedure.

A numbing medicine may be sprayed into your mouth to prevent the urge to cough or gag when the endoscope is inserted. A mouth guard will be inserted to protect your teeth and the endoscope.

Dentures must be removed.

After the Procedure

This is most often a simple surgery with a good outlook. Follow any self-care instructions you're given, including:

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

Outlook (Prognosis)

The stomach and abdomen will heal in 5 to 7 days. Moderate pain can be treated with medicine. Feedings will start slowly with clear liquids, and increase slowly.

Open References

References

Kessel D, Robertson I. Treating gastrointestinal conditions. In: Kessel D, Robertson I, eds. Interventional Radiology: A Survival Guide. 4th ed. Philadelphia, PA: Elsevier; 2017:chap 42.

Murray TE, Lee MJ. Gastrostomy and jejunostomy. In: Mauro MA, Murphy KP, Thomson KR, Venbrux AC, Morgan RA, eds. Image-Guided Interventions. 3rd ed. Philadelphia, PA: Elsevier; 2021:chap 91.

Twyman SL, Davis PW. Percutaneous endoscopic gastrostomy placement and replacement. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 92.

Gastrostomy tube placement - series
Presentation

<strong>Gastrostomy tube placement - series</strong><p>The stomach connects the esophagus to the small intestine, and acts as an important reservoir for food, prior to delivery to the small intestine.</p>

<strong>Indications</strong><p>Gastrostomy tubes are inserted for various reasons. They may be needed temporarily or permanently. Gastrostomy tube insertion may be recommended for; Birth defects of the mouth, esophagus, or stomach (esophageal atresia or tracheal esophageal fistula); Problems with sucking and/or swallowing, for example in patients debilitated by stroke or dementia.</p>

<strong>Incision</strong><p>While the patient is deep asleep and pain-free (general anesthesia), a small incision is made on the left side of the abdomen.</p>

<strong>Procedure, part 1</strong><p>A small, flexible, hollow tube (catheter) with a balloon or flared tip is inserted into the stomach. The stomach is stitched closed around the tube and the incision is closed.</p>

<strong>Procedure, part 2</strong><p>Alternatively, gastrostomy tubes can be placed under endoscopic guidance, using a much smaller incision (percutaneous endoscopic gastrostomy tube placement, or PEG). PEG tube placement can generally be performed under local anesthesia rather than general anesthesia. An endoscope is passed into the mouth, down the esophagus, and into the stomach. The surgeon can then see the stomach wall through which the PEG tube will pass. Under direct visualization with the endoscope, a PEG tube passes through the skin of the abdomen, through a very small incision, and into the stomach. A balloon is then blown up on the end of the tube, holding in place. PEG gastrostomy tubes avoid the need for general anesthesia and a large incision.</p>

<strong>Aftercare</strong><p>The stomach and abdomen generally heals in 5 to 7 days. Moderate pain can be managed with medications. The patient will be fed intravenously (IV) for at least 24 hours. Feedings will begin when bowel sounds are heard. Feedings will start slowly with clear liquids and gradually be increased. The patient/family will be taught; How to care for the skin around the tube; Signs and symptoms of infection; What to do if the tube is pulled out; Signs and symptoms of tube blockage; How to empty (decompress) the stomach through the tube; How and what to feed through the gastrostomy tube; How to conceal the tube under clothing; What normal activities can be continued.</p>

Gastrostomy tube placement - series
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Gastrostomy feeding tube - bolus

Tests for Feeding tube insertion - gastrostomy

Review Date: 5/29/2024

Reviewed By: Debra G. Wechter, MD, FACS, General Surgery Practice Specializing in Breast Cancer, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

Feeding tube insertion - gastrostomy

Description

Endoscopy

Why the Procedure Is Performed

Esophageal atresia

Fistula

Risks

Before the Procedure

IV

After the Procedure

Self-care instructions