What specialty should a patient with a feeding tube be referred to for removal?

Feeding Tube Removal: Specialty Referral

For feeding tube removal, refer to Gastroenterology for percutaneous endoscopic gastrostomy (PEG) tubes, or to General Surgery for surgically-placed tubes (jejunostomy, needle catheter jejunostomy), though many gastrostomy tubes with certain internal fixation devices can be removed at the bedside without specialist intervention.

Type-Specific Removal Approach

Nasogastric and Nasojejunal Tubes

• These tubes can be removed at the bedside by trained nursing or medical staff without specialist referral 1
• No special procedure or imaging is required for removal 1

Gastrostomy Tubes (PEG)

• Gastrostomy tubes with balloon-type internal fixation can be removed at the bedside by deflating the balloon and applying gentle traction—no specialist referral needed 1

• Gastrostomy tubes with rigid internal fixation devices have two removal options:

  • Traditional endoscopic removal by Gastroenterology 1
  • Alternative bedside removal: cut the tube close to the skin, push it into the stomach, and allow spontaneous passage through the GI tract 1

• The bedside "cut and push" method should not be used if there is any suspicion of distal strictures or adhesions, as approximately 2% of tubes will not pass spontaneously 1

Surgically-Placed Jejunostomy Tubes

• Refer to General Surgery for removal of needle catheter jejunostomy (NCJ) tubes placed during abdominal operations 1
• These tubes require surgical expertise due to their placement technique and potential complications 1

Gastrojejunostomy Tubes (GJ-tubes)

• Refer to Gastroenterology for removal, as these are typically placed endoscopically or radiologically 2, 3
• The dual-lumen design and jejunal extension require careful removal to avoid complications 2, 3

Critical Timing Considerations

• Early removal (within 7-10 days of placement): If a percutaneous tube becomes dislodged or requires removal during this period, replacement must be performed with endoscopic or image guidance due to immature tract formation 3

• Established tract (>2-3 weeks): After this period, the gastrocutaneous fistula tract is typically well-established and will prevent intraperitoneal leakage after tube removal 1

Common Pitfall to Avoid

• Do not attempt bedside removal of tubes with rigid internal fixation if the patient has known or suspected distal bowel obstruction, strictures, or adhesions—these require endoscopic removal by Gastroenterology 1