Gastrostomy Tube vs Nasogastric Tube Tolerance
For long-term enteral nutrition (>6 weeks), gastrostomy tubes are significantly better tolerated than nasogastric tubes, with lower rates of tube dislodgement, fewer intervention failures, and superior quality of life outcomes. 1
Duration-Based Approach to Tube Selection
Short-term feeding (<6 weeks):
- Nasogastric tubes are appropriate and can be used safely for limited periods 1
- Fine-bore nasogastric tubes may extend tolerability even beyond 6 weeks when gastrostomy placement is not suitable 1
Long-term feeding (>6 weeks):
- Percutaneous endoscopic gastrostomy (PEG) is the preferred access device (Grade B recommendation, 93% consensus) 1
- PEG should be preferred over surgical gastrostomy due to lower complication rates, cost-effectiveness, and shorter operating time (Grade B recommendation, 100% consensus) 1
Evidence for Superior Tolerance of Gastrostomy Tubes
Intervention failure rates:
- Gastrostomy tubes have dramatically lower intervention failure rates compared to nasogastric tubes (RR 0.18,95% CI 0.05-0.59) 2
- Treatment failure occurred in 18 of 19 nasogastric patients versus none in the gastrostomy group in one randomized trial 3
- Intervention failures include feeding interruption, tube blocking, tube leakage, and poor treatment adherence 1, 2
Tube dislodgement:
- Risk of tube dislodgement is significantly lower with gastrostomy tubes 1
- Self-extubation rates are markedly reduced with PEG (HR 0.17,95% CI 0.05-0.58) 4
Quality of life advantages:
- Gastrostomy tubes demonstrate superior quality of life across multiple domains 1, 2
- Patients report less inconvenience (RR 0.03,95% CI 0.00-0.29), less discomfort (RR 0.03,95% CI 0.00-0.29), less altered body image (RR 0.01,95% CI 0.00-0.18), and less interference with social activities (RR 0.01,95% CI 0.00-0.18) 2
Nutritional delivery:
- Gastrostomy patients receive a significantly greater proportion of prescribed feed (93% vs 55%, p<0.001) 3
- Better improvement in nutritional status including weight gain, mid-arm circumference, and serum albumin levels 1, 2, 3
Survival and Safety Outcomes
Mortality:
- In elderly hospitalized patients requiring long-term enteral nutrition, PEG use was associated with improved survival (HR 0.41,95% CI 0.22-0.76, p=0.01) 4
- However, systematic reviews show no significant difference in overall mortality rates between PEG and nasogastric tubes across all patient populations 1, 2
Aspiration risk:
- Lower incidence of aspiration with gastrostomy tubes in elderly patients (HR 0.48,95% CI 0.26-0.89) 4
- No significant difference in aspiration pneumonia rates in systematic reviews across all populations 1, 2
Complications:
- Overall complication rates are low with gastrostomy tubes (6.6% major, 6.6% minor complications) 5
- Minor complications may include wound infection and aspiration pneumonia (16% in one study) 3
Important Caveats and Nuances
Potential advantages of nasogastric tubes in specific contexts:
- Nasogastric tubes are associated with less dysphagia in some studies 1
- Earlier weaning after completion of radiotherapy in head and neck cancer patients 1
- These advantages are context-specific and do not outweigh the overall tolerance benefits of gastrostomy tubes for long-term use 1
Technical considerations:
- PEG placement using the "pull" technique shows the strongest evidence for reduced intervention failure (RR 0.07,95% CI 0.01-0.35) 2
- Pull-type PG tubes have longer median exchange intervals (405 days) compared to balloon-type tubes (210 days) 6
- Proper exit site care during the first 5-7 days post-procedure is essential to prevent infections 1
When gastrostomy is not suitable:
- If PEG placement is not feasible, percutaneous laparoscopic assisted gastrostomy (PLAG) is a safe alternative with the lowest complication rates among gastrostomy techniques 1
- For patients with gastroduodenal motility disorders, gastric outlet stenosis, or high aspiration risk, consider percutaneous endoscopic jejunostomy (PEJ) or PEG with jejunal extension 1