From the Guidelines
A G tube, or gastrostomy tube, is a moderately invasive feeding device that requires a surgical procedure for placement, carrying risks such as infection, bleeding, and tube displacement, but allows for long-term nutritional support when needed. The procedure for G tube placement can be done under local anesthesia with sedation or general anesthesia, and typically takes 30-45 minutes, involving a small incision in the abdomen and insertion of the tube using endoscopic guidance (PEG method) or with imaging assistance 1. The tube itself is a flexible silicone or polyurethane device with an external portion that remains outside the body and an internal portion with a retention device to prevent dislodgement.
Key Considerations
- The procedure can be performed on an outpatient basis or as a short hospital stay, with a designated team providing pre-assessment, peri-, and post-procedural care 1.
- The choice of insertion technique, such as PEG, surgical gastrostomy, or percutaneous radiological gastrostomy (PRG), depends on individual patient factors and the managing team's approach 1.
- While PEG is widely accepted as the insertion technique of choice due to its lower cost, simplicity, and lower complications, there are patients who may not be suitable candidates for PEG or may experience failed attempts at PEG placement 1.
Risks and Complications
- Major complications of G tube placement include aspiration, hemorrhage, peritonitis, and death, with frequencies ranging from 0.3-2.5% 1.
- Minor complications include ileus, peristomal infection, stomal leakage, and buried bumper, with frequencies ranging from 1-30% 1.
- Acute bleeding during endoscopy-guided gastrostomy placement is an uncommon complication, occurring in approximately 1% of cases, with risk factors including anticoagulation and previous anatomic alteration 1.
From the Research
Definition and Purpose of a G Tube
- A G tube, also known as a gastrostomy tube, is a medical device used to provide nutrition and fluids directly into the stomach [ 2 ].
- The primary purpose of a G tube is to support patients who have difficulty consuming food and fluids orally, due to various medical conditions such as neurological disorders, obstructive causes, or acute and chronic diseases [ 2 ].
Invasiveness of a G Tube
- The invasiveness of a G tube depends on the method of insertion, with percutaneous endoscopic gastrostomy (PEG) being a common procedure [ 2 ].
- PEG placement is considered a procedure with high hemorrhagic risk, and specific guidelines for antiplatelet or anticoagulant use should be followed strictly to reduce this risk [ 2 ].
- Rare complications of PEG tube insertion include iatrogenic injury to internal organs, such as the stomach, colon, small bowel, or liver, which may require urgent surgical intervention [ 3 ].
Risks and Contraindications
- The presence of ascites and ventriculoperitoneal shunts are considered additional risk factors for infection, and preventive precautions should be taken in these cases [ 2 ].
- Recent gastrointestinal bleeding due to peptic ulcer disease with risk of rebleeding is considered a relative contraindication to percutaneous enteral access procedures [ 2 ].
- Advanced dementia and a life expectancy shorter than 30 days are considered contraindications to PEG placement [ 2 ].