From the Guidelines
The primary difference between G-tube and PEG tube placement lies in their insertion methods, with G-tubes typically requiring a surgical incision and PEG tubes being placed endoscopically, as described in the 2025 update on endoscopic enteral access 1. The placement of G-tubes and PEG tubes differs significantly in terms of invasiveness and the skills required for insertion.
- G-tubes are usually placed through an open surgical procedure, which involves making an incision in the abdomen to create a stoma directly into the stomach, often under general anesthesia.
- In contrast, PEG tubes are placed using an endoscope, which is inserted through the mouth and guided into the stomach, allowing for the identification of the optimal insertion site on the abdomen with the aid of transillumination, as outlined in the study 1. Key steps in PEG placement include:
- Insufflation of the stomach to bring it closer to the abdominal wall
- Identification of the proper site, typically 2 cm below the costal margin, where maximal transillumination is observed
- Use of the "safe track technique" to ensure no interposed bowel loops or liver
- Creation of a small incision and insertion of a trocar needle into the stomach, through which a guide wire is placed and then secured to the gastrostomy tube
- The tube is then pulled from the skin entry site through the anterior abdominal wall, a method known as the "pull-technique" or alternatively, a "push-technique" can be used, as detailed in the 2025 clinical practice update 1. PEG tube placement is generally considered less invasive and can be performed with conscious sedation, offering faster recovery times and potentially fewer complications for eligible patients, as supported by the latest clinical guidelines 1.
From the Research
Placement of Gastrostomy (G-) Tube and Percutaneous Endoscopic Gastrostomy (PEG) Tube
The placement of G-tubes and PEG tubes differs in several aspects, including:
- Insertion technique: PEG tubes are inserted using a percutaneous endoscopic approach, whereas G-tubes can be inserted using various methods, including surgical, endoscopic, and laparoscopic techniques 2.
- Indications: Both PEG and G-tubes are used for enteral nutrition, but PEG tubes are often preferred for patients with head and neck cancer, stroke, and other conditions that require long-term nutrition support 3.
- Complications: PEG tubes have been associated with lower complication rates compared to G-tubes, including lower rates of tube dislodgement and mortality 3.
- Aftercare and replacement: PEG tubes require regular aftercare and may need to be replaced or converted to a low-profile button, whereas G-tubes may require less maintenance 4.
Comparison of PEG and G-Tube Placement Techniques
Studies have compared the outcomes of PEG and G-tube placement techniques, including:
- A retrospective review of 137 patients who underwent PEG or G-tube insertion found that PEG tubes had a significantly lower tube dislodgement rate and lower 1-year mortality rate compared to G-tubes 3.
- A study of pediatric patients found that laparoscopic gastrostomy tube placement had similar major complication rates compared to PEG tube placement, but PEG tubes were associated with more discrete anesthesia exposures and subsequent procedures 4.
- A comparison of surgical, endoscopic, and laparoscopic methods for gastrostomy tube placement found that PEG tubes had shorter insertion times and lower complication rates compared to surgical and laparoscopic methods 2.
Key Differences Between PEG and G-Tubes
The key differences between PEG and G-tubes include:
- Insertion technique: PEG tubes are inserted using a percutaneous endoscopic approach, whereas G-tubes can be inserted using various methods.
- Complication rates: PEG tubes have been associated with lower complication rates compared to G-tubes.
- Aftercare and replacement: PEG tubes require regular aftercare and may need to be replaced or converted to a low-profile button.
- Indications: Both PEG and G-tubes are used for enteral nutrition, but PEG tubes are often preferred for patients with certain conditions that require long-term nutrition support 5, 6.