From the Guidelines
A gastrostomy tube (G-tube) should be discontinued when the patient's condition has changed and the expected benefits of enteral nutrition (EN) are no longer anticipated, or when the patient's ability for oral feeding has improved substantially. This decision should be based on regular assessments of the patient's condition and the indication for EN, as recommended by the ESPEN guideline on clinical nutrition and hydration in geriatrics 1. The patient should be able to consistently meet their nutritional and hydration needs orally, and have no signs of aspiration with oral intake.
Some key factors to consider when deciding to discontinue a G-tube include:
- The patient's ability to consume at least 75% of their caloric requirements by mouth for a consecutive period
- Adequate weight maintenance or appropriate weight gain
- No signs of aspiration with oral intake
- Resolution or adequate management of the underlying condition that necessitated G-tube placement
- A swallowing evaluation by a speech therapist to confirm safe swallowing function
The decision to discontinue a G-tube should involve a multidisciplinary approach, including the primary physician, dietitian, and sometimes a gastroenterologist. After removal, the site typically closes spontaneously within 24-72 hours, though some may require surgical closure. Patients should be monitored for complications after removal, such as persistent leakage or infection at the site. The timing of G-tube removal is individualized based on the patient's specific medical condition, nutritional status, and overall health goals, as suggested by guidelines for enteral feeding in adult hospital patients 1.
From the Research
Determining When to Discontinue G Tube
To determine when a G tube should be discontinued, several factors should be considered.
- The patient's overall health and nutritional status should be evaluated to ensure that they can tolerate oral nutrition without the need for enteral support 2.
- The presence of any underlying conditions that may affect the patient's ability to eat and digest food normally should be assessed 3.
- The patient's ability to meet their nutritional needs through oral intake should be evaluated, and the G tube can be discontinued if they are able to do so 4.
Considerations for Discontinuing G Tube
When considering discontinuing a G tube, the following factors should be taken into account:
- The patient's gastric motility and ability to tolerate oral nutrition without experiencing gastrointestinal symptoms such as nausea, vomiting, or abdominal pain 5, 6.
- The patient's overall quality of life and ability to participate in daily activities without the need for enteral support 3.
- The presence of any complications or adverse events related to the G tube, such as infection, leakage, or blockage, which may necessitate discontinuation 2.
Clinical Guidelines
Clinical guidelines for the placement and management of G tubes, including discontinuation, should be followed to ensure optimal patient outcomes 3, 2.
- A team approach, including healthcare professionals from various disciplines, should be used to evaluate the patient's needs and develop a plan for discontinuing the G tube 3.
- Close monitoring and follow-up are necessary to ensure a smooth transition to oral nutrition and to address any complications that may arise 2.