What is the preferred choice between a G (gastrostomy) tube and a PEG (percutaneous endoscopic gastrostomy) tube for long-term enteral nutrition?

PEG Tube vs G Tube for Long-Term Enteral Nutrition

For long-term enteral nutrition (>6 weeks), a PEG (percutaneous endoscopic gastrostomy) tube is strongly preferred over a surgical gastrostomy (G tube) due to lower complication rates, better cost-effectiveness, and shorter operating time. 1

Evidence-Based Comparison

PEG Tube Advantages

• Lower complication rates compared to surgical gastrostomy 1
• More cost-effective than surgical alternatives 1
• Shorter procedure time 1
• Lower risk of inpatient adverse events including:
  • Significantly lower risk of colon perforation 2
  • Lower infection rates at insertion site 2
  • Reduced hemorrhage requiring blood transfusion 2
  • Lower 30-day readmission rates 2
  • Lower inpatient mortality 2
• Technical success rate >99% with procedure-related mortality of approximately 2% 3, 4
• Better quality of life compared to nasogastric tubes 1

Clinical Outcomes

• Improved survival in elderly hospitalized patients compared to nasogastric feeding 1
• Better tolerated with lower incidence of aspiration compared to nasogastric tubes 1
• Fewer intervention failures (e.g., feeding interruption, tube blockage, leakage) 1
• Better nutritional status improvement compared to nasogastric tubes 1
• Lower risk of tube dislodgement compared to nasogastric tubes 1

Decision Algorithm for Enteral Access

1. Duration of feeding requirement:

   • Short-term (<6 weeks): Consider nasogastric tube 1
   • Long-term (>6 weeks): PEG tube preferred 1

2. If PEG is indicated but not feasible:

   • Consider percutaneous laparoscopic assisted gastrostomy (PLAG) as a safe alternative 1
   • Radiologically inserted gastrostomy (RIG) should be reserved only for patients in whom endoscopic technique is not possible 1

3. Special clinical considerations:

   • For patients with gastroduodenal motility disorders, gastric outlet stenosis, or high aspiration risk: Consider PEJ (percutaneous endoscopic jejunostomy) or PEG/J (PEG with jejunal extension) 1

Important Caveats and Pitfalls

1. Contraindications to enteral feeding:

   • Severe functional disturbances of the bowel
   • Gastrointestinal obstruction
   • Gastrointestinal tract bleeding
   • Severe malabsorption
   • Severe metabolic imbalances 1

2. Post-procedure care:

   • Daily monitoring of the PEG exit site until stoma tract formation (5-7 days)
   • Keep site clean and dry using aseptic wound care 1
   • Monitor for complications: bleeding, pain, erythema, induration, leakage, and inflammation 1

3. Tube selection considerations:

   • Larger caliber tubes (CH-15) may be less frequently obstructed and easier to handle than smaller tubes (CH-9) 5
   • Consider a multidisciplinary nutrition support team approach to reduce complications 3, 6

The evidence strongly supports PEG as the preferred method for long-term enteral access over surgical gastrostomy (G tube), with significant advantages in terms of morbidity, mortality, and quality of life outcomes.