Does food go through a G-tube (Gastrostomy tube) or a GJ tube (Gastrojejunostomy tube)?

Feeding Through G-Tube vs GJ-Tube: Anatomical Differences and Clinical Applications

Food and nutritional formulas are administered through a G-tube (Gastrostomy tube) into the stomach, while a GJ-tube (Gastrojejunostomy tube) has two ports - one for gastric decompression and another that delivers food directly into the jejunum, bypassing the stomach. 1

Anatomical Placement and Function

• G-tubes are placed directly into the stomach through the abdominal wall, allowing for bolus or continuous feeding into the gastric reservoir 2, 3
• GJ-tubes have a dual-lumen design with:
  • A gastric port that accesses the stomach for decompression and medication administration
  • A jejunal extension that passes through the pylorus into the jejunum for direct small bowel feeding 1, 3

Feeding Methods and Considerations

G-tube Feeding

• Allows for bolus, intermittent, or continuous feeding methods due to the stomach's reservoir capacity 2
• Can accommodate 200-400 ml of feed administered over 15-60 minutes at regular intervals 2
• Permits gravity feeding using a syringe with the plunger removed 2
• Suitable for most patients requiring enteral nutrition without specific contraindications 2

GJ-tube Feeding

• Requires continuous infusion rather than bolus feeding due to loss of the stomach reservoir 1
• Bolus delivery into the jejunum must be avoided as it can cause "dumping syndrome" with symptoms of bloating, diarrhea, and abdominal discomfort 2, 4
• Continuous pump feeding is necessary when using the jejunal port 1, 5

Clinical Indications for Each Tube Type

G-tube Indications

• Neurological disorders of swallowing (stroke, multiple sclerosis, motor neurone disease) 2
• Cognitive impairment and depressed consciousness 2
• Mechanical obstruction to swallowing (oropharyngeal or esophageal cancer) 2
• Long-term partial failure of intestinal function requiring supplementary intake 2

GJ-tube Indications

• Patients at high risk for aspiration or with history of aspiration pneumonia 1, 3
• Gastroesophageal reflux that cannot be managed medically 2, 1
• Gastroparesis or delayed gastric emptying 3, 6
• Need for simultaneous gastric decompression and jejunal feeding 1, 7
• Early postoperative feeding in certain surgical patients 2

Complications and Considerations

G-tube Complications

• Higher risk of aspiration compared to jejunal feeding, especially in supine position 2
• Gastroesophageal reflux occurs frequently with gastric feeding 2
• Risk of aspiration pneumonia, particularly in patients with impaired consciousness 2

GJ-tube Complications

• Mechanical issues including tube kinking or coiling in the stomach 1, 4
• Jejunal extension displacement or migration back into the stomach 6
• Diarrhea and abdominal distension are more common with jejunal feeding 1, 4
• More technically challenging to place and maintain compared to G-tubes 2, 7

Practical Management Tips

• For G-tube feeding, patients should be positioned at 30° or more upright during and for 30 minutes after feeding to minimize aspiration risk 2
• For GJ-tube feeding, continuous rather than bolus feeding is required through the jejunal port 1
• Monitor for tube blockage in both types, but especially in GJ-tubes due to smaller jejunal extension diameter 4
• Flush tubes with water before and after every feed or medication to prevent blockage 2

By understanding the anatomical differences and specific feeding requirements for each tube type, clinicians can optimize nutritional support while minimizing complications in patients requiring enteral nutrition.