Gastrostomy tubes are generally used for providing long-term fluid and nutrition for children or adults who cannot take in adequate amounts by mouth. The two most common reasons for G-tubes are dysphagia (difficulty in swallowing) and malnutrition (also called failure to thrive).
The gastrostomy tube is a tube which goes through the skin and tissues of the body wall directly into the stomach. The tube is a convenient way to access the GI tract.
Alternative names:
G-tube, g-button, PEG, Mic-Key’s®, Bard® Buttons
Initial placement:
- Open surgery: usually done at the time of another operation
- Percutaneous Endoscopic Gastrostomy (PEG): a common approach in which a flexible endoscope is passed through the mouth into the stomach. A site for the tube placement is identified below the left rib cage which has no intervening liver or bowel. A needle is placed through the skin and into the stomach. A guidewire is then passed through the needle and into the stomach. This wire is then pulled back up the esophagus and out the mouth. The specially constructed PEG tube is then slid over the guidewire and disassembled. The top wings are against the skin to prevent it from pulling into the stomach, while the rounded solid portion (the button) stays in the stomach preventing it from coming out.
- Laparoscopic Gastrostomy: a small (3 to 5mm) camera lens is inserted through the belly button. An incision is made at the chosen site for the G-tube and a laparoscopic port placed. The stomach is grasped at the chosen spot and the tube is inserted under laparoscopic vision by a variety of techniques.
Granulation tissue:
After the tube has been in place for several weeks, a tract forms. The body forms this tract by generating an inflammatory tissue called “granulation” tissue. It is normal to have granulation tissue in the tract, but the tissue can sometime extend far beyond the tract. It is usually harmless, but can bleed easily. Silver nitrate can be used to destroy the granulation tissue, but it often comes back. Medications such as Dilantin increase the production of granulation tissue. Some people use a steroid cream to decrease the granulation tissue, but only some patients have any response to steroid cream.
Types of Gastrostomy tubes:
G-tubes can generally be divided into 3 type:
- Long tubes (Foleys, Pezzars, Malecots, etc)
- Bard-type buttons (Bard®, Microvasive®, Nutristar®, others)
- Balloon-type buttons (Mic-Key®, Nutriport®, AMT Mini®, others)
| Type | Advantages | Disadvantages | Life (in our patients) |
|---|---|---|---|
| Long tubes | Inexpensive Connection distant from sensitive skin Simple Less mechanical failure |
Dislodgement Cosmetically unappealing Can be pulled into distal GI tract |
2 to 6 months |
| Bard-type | Durable Hard to pull out accidentally Long life Simple to connect Low profile against the skin Very common |
Mechanical valve can wear out Painful to change Frequently disconnects in active children |
6 months to 4 years |
| Balloon-type | Easy to exchange (family can do it at home) Painless changes Balloon decreases leakage around tube Locking connectors |
Mechanical failure of balloon or valve Shorter life span Some are higher profile than Bard-types |
Usually about 6 months |
Complications:
Leakage around the tube: The best treatment for this problem is to stabilize the tube so that the body closes in around the tube. Increasing the tube size only leads to an enlarged hole and more leakage. In patients with a balloon-type tube, the water in the balloon can be increased to block to hole better and decrease leakage.
Leakage through the tube: This is caused by failure of the one-way valve. Sometime this is due to a food particle propping the valve open. Try flushing the tube with some water. If this fails to solve the problem, the tube should be changed.
Blockage of the tube: Try flushing the tube with warm water. If a portion of the cap has broken off in the tube, your surgeon can probably retrieve it in the office. If these measures fail, the tube should be replaced.
Infection: It is normal to have some redness around the tube. If it extends more than 1 inch (in radius) away from the tube, we usually treat with oral antibiotics.
Granulation tissue: Granulation tissue can be cauterized with silver nitrate sticks in the office or at home. If the granulation tissue is stable, it can be left alone. Stabilizing the tube and preventing leakage decrease granulation tissue.
Bleeding: Mild bleeding (3-5 mL) is not a problem. Hold pressure with tissue paper or gauze and leave the tissue paper in place if the bleeding stops. If ongoing or recurrent bleeding occurs, call your surgeon.
Irritation around the site: This is usually caused by leakage around the G-tube site. First try to decrease the leakage. Protective creams such as Criticaid, ILEX cream, calseptin, or other protective salves can be tried.
Tenderness upon connection: Tenderness is common for the first 1 to 2 weeks. If it persists, the connection tube can be secured with tape or duoderm to the body and left connected. This allows the connection to the pump to be done away from the skin until the tenderness goes away.
