Gastrostomy: Permanent and Temporary

Gastrostomy is a surgical procedure to place a tube through the abdomen and into the stomach.

Parts of the body involved:

Stomach, abdomen.

Reasons for the procedure:

A gastrostomy can provide a route for feedings or allow the stomach to be drained and kept empty. The procedure is most often performed for the following reasons:

• To feed a person who is unable to suck or swallow due to stroke, cancer, traumatic facial injury, birth defect or other medical condition
• To feed a person who cannot eat enough food by mouth to provide proper nutrition
• To provide a route for tube feeding when it is needed for four weeks or longer
• To act as a drainage tube to bypass obstruction from a tumor, scarring or ulcer

Risk factors that may lead to complications:

• Advanced age
• Pre-existing medical conditions
• Blood clotting (coagulation) deficits
• Debilitation
• Confusion (patient may pull the tube out)

What to expect before the procedure:

• Physical exam
• Assessment of swallowing ability

The day before and the day of your procedure:

• Arrange to have someone drive you to and from the procedure.
• The night before, eat a light meal and do not eat or drink anything after midnight unless told otherwise by your doctor.
• Wear comfortable clothing.

During the procedure:

IV fluids, anesthesia and possibly a sedative.

Anesthesia:

General or local with a sedative, depending on the type of procedure. An open procedure requires general anesthesia. The more common endoscopic placement is performed with a local anesthetic and a sedative.

Description of the procedure:

• There are two methods used to perform a gastrostomy — an open surgical procedure and the more common percutaneous (through the skin) endoscopic gastrostomy (PEG).
• Percutaneous endoscopic gastrostomy tube placement (PEG): The doctor threads a gastroscope (a type of endoscope, which is a long, thin tube with a light and camera at the end), through the mouth, down the throat and into the stomach. Air is injected to stretch and enlarge the stomach. The doctor looks through the scope into the stomach and uses the endoscope to assist with tube placement.
• Local anesthesia is injected at the site where the tube will be. A percutaneous needle is inserted through the skin and abdominal wall and into the stomach. A guide wire is passed through this needle and into the stomach, where it is clamped, and the needle is removed. The endoscope is removed, and the gastrostomy tube is gently guided through the mouth, down the throat and into the stomach. The tube is then pulled partly out of the body through the incision in the abdominal wall. The endoscope is reinserted through the mouth and into the stomach to help secure the inside portion of the tube. The outside portion of the tube is also secured, then cut to the correct size and fitted with a connector. Once the tube is in place, the stomach is deflated.
• Open placement: This method is no longer routinely performed due to the risks associated with an open surgical procedure. It may be done at the same time as other stomach surgery or if you cannot tolerate an endoscopy. The surgeon makes an incision through the skin, abdominal wall and, once in the body, another one into the stomach. A tube is placed through the skin and into the stomach and is stitched into place. The surgeon closes the incision.

After the procedure:

The doctor will verify the correct placement of the tube.

How long will it take?

Most PEG procedures take less than 30 minutes.

Will it hurt?

Anesthesia prevents pain during the procedure.

Possible Complications:

• Infection
• Bleeding
• Anesthesia-related problems
• Skin irritation around the tube
• Dislodging of the tube
• Diarrhea

Average hospital stay:

None. Patients receiving a PEG tube usually return home the same day unless they are in the hospital for treatment of another condition.

Postoperative care:

Depending on your medical condition, you may need to be fed intravenous fluids for the first day or two after gastrostomy tube placement or until your intestine is working normally. You'll then be started on clear liquids and gradually advance to thicker liquid and solid foods, as you can tolerate them.

Other important considerations:

• Keep the tube insertion site clean and dry.
• Wash your hands before touching the area.
• Take all antibiotics if they are ordered; do not stop even if you feel healthy.
• Learn how to administer tube feedings and flush out your tube to decrease the risk of blockages.
• Learn how to handle possible serious complications, such as a dislodged tube or aspiration.

Outcome:

You will receive feedings through the tube, so you, and if necessary, your caregiver, will learn how to care for the tube, administer feedings and check for problems. Dislodging is most common during the first two weeks the tube is in place.

Call your doctor if any of the following occurs:

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding or discharge from the incision site around the tube
• The tube clogs or falls out
• Cough, shortness of breath, chest pain or severe nausea or vomiting
• Inability to pass gas or defecate
• Severe abdominal pain
• New abdominal bloating