A gastrostomy tube, commonly referred to as a G-tube, is a flexible device surgically placed through the abdominal wall directly into the stomach. This tube provides a path for delivering nutrition, fluids, and medication when oral intake is not possible or sufficient. The procedure, known as a gastrostomy, creates a semi-permanent opening called a stoma, which bypasses the mouth and esophagus. G-tube placement ensures adequate caloric intake and hydration for patients needing long-term enteral access.
Understanding Why a G-Tube is Necessary
G-tube placement is recommended for patients who require nutritional support for four weeks or longer due to an inability to safely or adequately eat by mouth. A frequent indication involves neurological disorders like stroke, cerebral palsy, or amyotrophic lateral sclerosis, which cause severe difficulty with swallowing, known as dysphagia. When swallowing is impaired, there is a risk of aspirating food or liquid into the lungs, which can lead to aspiration pneumonia.
The tube is also used for individuals who cannot consume enough calories to maintain a healthy weight and support growth, often termed “failure to thrive.” This includes patients recovering from complex head and neck surgeries, those with congenital abnormalities of the mouth or esophagus, or people with severe gastrointestinal conditions. Beyond feeding, a G-tube can be used for venting the stomach to relieve gas or fluid buildup, which is helpful in cases of bowel obstruction or severe nausea.
Methods Used During the Surgical Procedure
The most common technique for placing a G-tube is Percutaneous Endoscopic Gastrostomy (PEG), a minimally invasive approach. A physician uses an endoscope—a flexible tube with a camera—passed through the mouth and down into the stomach to visualize the lining. The stomach is inflated with air to bring its wall closer to the abdominal wall, and the endoscope’s light identifies the best external placement site.
After the site is numbed, a small incision is made, and a needle is passed into the stomach, followed by a guide wire. The physician uses the endoscope to grasp the wire and pull it up through the esophagus and out the mouth. The G-tube is then attached to this wire and pulled back down through the esophagus, stomach, and out the abdominal wall. A retention bumper is positioned against the internal stomach wall to secure the tube.
An alternative method is laparoscopic gastrostomy, performed by a surgeon using a laparoscope inserted through a small incision, usually near the belly button. This technique offers direct visualization of the abdominal cavity and is often preferred for patients with complex anatomy or previous abdominal surgeries. The surgeon fixes the stomach to the abdominal wall before inserting the tube, which may lower the risk of dislodgement or complications compared to the PEG method. Open surgical gastrostomy, involving a larger incision, is reserved for cases where other methods are not feasible or when other procedures, such as a fundoplication, are performed concurrently.
Immediate Recovery and Hospital Stay
Immediately following the procedure, patients are monitored in a recovery area while waking up from anesthesia. Pain at the insertion site, which may feel like a pulled muscle, is managed with oral or intravenous pain medications, often including scheduled doses of acetaminophen and ibuprofen. The incision site will have a sterile dressing that is monitored for excessive bleeding or signs of infection.
The hospital stay is generally short, often ranging from same-day discharge to one or two nights, particularly after a PEG procedure. Tube usage typically begins within a few hours, starting with small water flushes to confirm patency and tolerance. Enteral feeding is initiated slowly, often within 3 to 4 hours post-procedure, gradually increasing the volume and formula concentration before discharge.
Long-Term Care and Living with a G-Tube
Proper long-term care of the G-tube and the surrounding stoma site is crucial for preventing infection and ensuring correct function. The skin around the tube, known as the stoma, must be cleaned daily with mild soap and water or a saline solution to remove drainage or debris. Keeping the site clean and dry is important, as excessive moisture can lead to skin irritation or breakdown.
When administering feeds, medications, or water, the tube should be flushed before and after use to prevent clogging and residue buildup. Caregivers must ensure the external bolster, the part of the tube resting against the skin, is not too tight. A small gap, about a quarter of an inch, should remain to prevent pressure injury to the skin and stomach tissue. Many patients eventually transition to a low-profile tube, often called a “button,” which sits flush against the skin and requires a separate extension set for use. These tubes are typically replaced every few months to a year in a clinic without the need for surgery.