Does a mature gastrostomy (gastrostomy tube) tract close on its own?

Does a Mature Gastrostomy Tract Close on Its Own?

Yes, a mature gastrostomy tract typically closes spontaneously within days to weeks after tube removal, though the closure timeline and reliability depend on how long the tube was in place. 1, 2

Understanding Tract Maturation

A gastrostomy tract is considered "mature" once the stomach wall has firmly adhered to the anterior abdominal wall, creating a stable fistulous connection. This maturation process typically occurs within 7-10 days after initial placement, though it may be delayed up to 4 weeks in patients with malnutrition, ascites, or those receiving corticosteroid treatment. 1, 3

Spontaneous Closure After Tube Removal

Expected Closure Pattern

• The standard management for removing a gastrostomy tube from a mature tract is simply removing the tube and allowing the fistula to close spontaneously. 1, 2
• The American Gastroenterological Association recommends instructing patients that the stoma typically closes within days to weeks after removal. 2
• During this closure period, patients should keep the area clean and dry with simple gauze dressing changes daily until the stoma closes. 2

Factors Affecting Closure

The likelihood and speed of spontaneous closure depends significantly on:

• Duration of tube placement: Tubes in place for extended periods (years) may develop more established tracts that are slower to close or may result in persistent sinus tracts. 4
• Tract maturity: Fully mature tracts with complete epithelialization of the gastrocutaneous fistula are more likely to close predictably. 1
• Patient factors: Nutritional status, wound healing capacity, and absence of infection influence closure rates. 1, 2

When Surgical Closure Is Required

Surgery is rarely needed but becomes necessary when:

• Signs of peritonitis develop after tube removal. 1, 5
• The fistula fails to heal with conservative management after an appropriate observation period. 1, 5
• Persistent abdominal wall sinus tracts develop, particularly with long-term indwelling tubes. 4

Critical Safety Considerations

Immature Tract Removal (Before 7-10 Days)

Never remove a tube from an immature tract without endoscopic or radiologic guidance, as the stomach and abdominal wall can separate, resulting in free perforation into the peritoneal cavity. 1, 2 This represents a surgical emergency requiring immediate intervention. 1

High-Risk Patients

Patients with malnutrition, ascites, or on corticosteroids may require up to 4 weeks for adequate tract maturation and may have delayed or incomplete closure after removal. 1, 2

Post-Removal Monitoring

Patients should be instructed to report warning signs including:

• Fever or increasing abdominal pain 2
• Purulent drainage from the site 2
• Persistent leakage of gastric contents 2
• Any signs of peritonitis 2

Prevention of Persistent Tracts

To minimize the risk of persistent fistulas or complications:

• Avoid excessive lateral traction on the tube during its functional period. 1, 5
• Ensure proper external fixation without excessive compression. 3
• Consider anterior gastropexy at initial placement, which reduces the risk of tract complications and facilitates safer management if premature removal occurs. 1, 6