Can a Gastrostomy (G) tube be removed at the bedside?

G-Tube Removal at the Bedside

Yes, gastrostomy tubes can be safely removed at the bedside in most cases, but only after the tract has matured (typically 7-10 days, up to 4 weeks in high-risk patients), and the removal technique depends on tube type and clinical context. 1

Timing Considerations: When Is Bedside Removal Safe?

The critical determinant is tract maturation status:

• Mature tracts (>7-10 days): Bedside removal is safe and appropriate 1
• Immature tracts (<7-10 days): Removal requires endoscopic or image guidance due to risk of free perforation if the stomach separates from the abdominal wall 1
• Delayed maturation (up to 4 weeks) occurs in patients with malnutrition, ascites, or corticosteroid treatment 1

Removal Techniques by Tube Type

Balloon-Type Tubes (Most Common)

Simple bedside removal is standard:

• Deflate the balloon completely 2
• Gently withdraw the tube through the tract 2
• No endoscopy required 3

Internal Bumper Tubes (PEG-Type)

The "cut and push" method is safe and evidence-based:

• Cut the external portion of the catheter at skin level 3
• Allow the internal bumper to pass spontaneously through the GI tract 3
• Complication rate is only 2.7% in a series of 73 removals 3
• This method saves significant resources and avoids unnecessary endoscopy in frail patients 3

Low-Profile Devices (Button Gastrostomy)

Bedside removal is straightforward:

• Deflate the balloon with sterile water 2
• Remove by gentle traction 1

Post-Removal Management

After tube removal, the tract typically closes spontaneously:

• Fistulas usually close without intervention when the tube is simply removed 1
• Surgery is rarely required unless peritonitis develops or the fistula fails to heal 1
• Monitor for signs of infection or peritonitis 1

Critical Safety Considerations

Never attempt bedside removal in these situations:

• Tract age <7-10 days (use endoscopy or image guidance instead) 1
• Presence of active infection at the insertion site 2
• Signs of peritonitis or decompensation 1
• Patients with malnutrition, ascites, or on corticosteroids within the first 4 weeks (delayed tract maturation) 1

Common Pitfalls and How to Avoid Them

Premature removal is the most dangerous complication:

• If a tube is accidentally removed before tract maturation, the stomach can separate from the abdominal wall, causing free perforation 1
• If recognized immediately, place a new tube through the original site to seal the stomach against the abdominal wall 1
• If recognition is delayed, initiate NG suction, broad-spectrum antibiotics, and plan repeat gastrostomy in 7-10 days 1
• Reserve surgical exploration for patients with peritonitis or decompensation 1

Avoid excessive force during removal:

• Gentle traction prevents tract disruption 2
• For balloon tubes, ensure complete deflation before removal 2

When Endoscopic Removal Is Necessary

Reserve endoscopy for specific scenarios:

• Immature tracts (<7-10 days) 1
• Suspected complications (colocutaneous fistula, buried bumper syndrome) 1
• Inability to deflate balloon 1
• Clinical uncertainty about tract maturity 1