Gastrostomy tube placement - series?

Answer 1

Normal anatomy

The stomach connects the esophagus to the small intestine, and acts as an important reservoir for food, prior to delivery to the small intestine .

Indications

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

Incision

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

Procedure, part 1

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.

Procedure, part 2

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.

Aftercare

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

Reviewed By

Review Date: 04/26/2010

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.