What are the complications associated with Gastrostomy (G) tube placement?

From the Guidelines

Gastrostomy (G) tube placement is associated with various complications, including mechanical issues like tube dislodgement, blockage, or breakage, as well as medical complications such as aspiration pneumonia, peritonitis, and buried bumper syndrome, with the most frequent complication being local wound infection, occurring in approximately 15% of cases 1. The complications can be categorized into:

• Mechanical complications: tube dislodgement, migration, blockage, or breakage, which may require tube replacement
• Medical complications: aspiration pneumonia, peritonitis, buried bumper syndrome, and dumping syndrome
• Infection at the insertion site: presenting with redness, swelling, and discharge
• Nutritional complications: malabsorption, electrolyte imbalances, and vitamin deficiencies
• Long-term complications: adhesions, potential bowel obstruction, and granulation tissue formation around the stoma According to the most recent study 1, percutaneous tubes should be used instead of nasal tubes for long-term needs to reduce mechanical complications, and routine water flushing after feedings can prevent tube occlusion. To minimize these complications and ensure effective enteral nutrition delivery, regular monitoring, proper tube care, and prompt attention to any issues are essential 1. Key strategies to reduce aspiration include elevation of the head of the bed, post-pyloric feeding, and administration of motility agents to promote gastric emptying 1. Proper management of complications is crucial to prevent severe consequences, such as pneumonia, respiratory failure, or death, and to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.

From the Research

Complications Associated with Gastrostomy (G) Tube Placement

The complications associated with Gastrostomy (G) tube placement can be categorized into several types, including:

• Mechanical failure, such as clogging, cracking, and deterioration of the tube 2
• Dislodgement of the tube 2, 3
• Bowel perforation, which can be life-threatening 2, 4, 5
• Aspiration, which can lead to respiratory complications 2, 5
• Feeding intolerance, which can result in malnutrition and dehydration 2, 3
• Infection, bleeding, vomiting, and obstruction of the tube 4
• Regurgitation of the tube, which can occur due to protracted vomiting 4

Patient-Specific Complications

Certain patient populations may be at higher risk for complications, including:

• Children under 10kg, who have a higher risk of perforation 5
• Patients with neurological diseases, respiratory diseases, and gastrointestinal tract disorders, who may experience persistent or new symptoms after tube insertion 3
• Patients who require surgical intervention, which can result in major complications and mortality 3, 5

Management and Prevention of Complications

Healthcare providers play an active role in preventing, managing, and supporting patients and parents/caregivers in dealing with complications associated with G tubes 6. Regular replacement of GJ tubes can help prevent some complications, and methods such as guidewire, gastroduodenoscopy-guidewire, esophagogastroduodenoscopy-forceps, and fluoroscopy-guidewire can be used to direct a GJ tube 2.