Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Gastrostomy Tube Replacement

  • Author: Erik D Schraga, MD; Chief Editor: Vikram Kate, MBBS, PhD, MS, FRCS, FRCS(Edin), FRCS(Glasg), FACS, FACG, FIMSA, MAMS, MASCRS  more...
 
Updated: Mar 21, 2016
 

Background

Gastrostomy tube (G-tube) placement (placing a tube into the stomach)[1, 2] to provide nutrition and medication for patients unable to feed themselves was first described in the mid-19th century. Initially, this procedure was often complicated by the development of peritonitis and a high mortality. Currently, however, G-tube placement now routinely occurs with few complications when placed percutaneously and guided by endoscopy or interventional radiology techniques.[3] Neurologic disease is the most common indication for G-tube placement.[4]

Patients with dislodged G-tubes often present to the emergency department (ED) or other acute care setting to have their tube replaced. This article focuses on G-tube replacement, but the technique can be extended to duodenostomy and jejunostomy tubes as well.[5]

Next

Indications

A G-tube should be replaced as quickly as possible in the ED, unless the tube was recently placed.

A feeding tube tract can narrow or close within hours of tube removal.

A simple gastrostomy requires approximately 1-2 weeks to form a tract.[6] More complicated procedures, such as the Witzel tunnel, may take 3 weeks to create a mature tract.

If the tract appears fresh, immediately contact the provider who placed the tube before initiating ED replacement; operative or fluoroscopic replacement may be required.

Previous
Next

Contraindications

Replacing a G-tube that has not formed a tract can lead to misplacement in the peritoneal cavity. As mentioned above, simple G-tubes generally take 1-2 weeks to form a mature tract. Information on when the G-tube was initially placed should be obtained to determine whether nonoperative ED tube replacement can proceed safely.

Replacement should not be performed if any evidence of infection (see the image below), such as extensive erythema, exudate, or warmth, is appreciated around the G-tube site.

Regarding tube-site infections, most catheter-relaRegarding tube-site infections, most catheter-related infections involve local cellulitis, as shown here, with erythema and tenderness. These infections frequently respond to local wound care and oral antibiotics.
Previous
 
 
Contributor Information and Disclosures
Author

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Vikram Kate, MBBS, PhD, MS, FRCS, FRCS(Edin), FRCS(Glasg), FACS, FACG, FIMSA, MAMS, MASCRS Professor of General and Gastrointestinal Surgery and Senior Consultant Surgeon, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India

Vikram Kate, MBBS, PhD, MS, FRCS, FRCS(Edin), FRCS(Glasg), FACS, FACG, FIMSA, MAMS, MASCRS is a member of the following medical societies: American College of Gastroenterology, American College of Surgeons, American Society of Colon and Rectal Surgeons, Royal College of Surgeons of England, Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

Additional Contributors

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the assistance of Lars Grimm, MD, with the literature review and referencing for this article, as well as the contributions of previous author Suzanne M Miller, MD, to the development and writing of this article.

References
  1. Galat SA, Gerig KD, Porter JA, et al. Management of premature removal of the percutaneous gastrostomy. Am Surg. 1990 Nov. 56(11):733-6. [Medline].

  2. Locker DL, Foster JE 2nd, Craun ML, et al. A technique for long term continent gastrostomy. Surg Gynecol Obstet. 1985 Jan. 160(1):73-5. [Medline].

  3. Anis MK, Abid S, Jafri W, Abbas Z, Shah HA, Hamid S, et al. Acceptability and outcomes of the Percutaneous Endoscopic Gastrostomy (PEG) tube placement--patients' and care givers' perspectives. BMC Gastroenterol. 2006 Nov 24. 6:37. [Medline].

  4. Lee TH, Shih LN, Lin JT. Clinical experience of percutaneous endoscopic gastrostomy in Taiwanese patients--310 cases in 8 years. J Formos Med Assoc. 2007 Aug. 106(8):685-9. [Medline].

  5. Kaufman Z, Shpitz B, Dinbar A. Reinsertion of a catheter for feeding jejunostomy. Surg Gynecol Obstet. 1984 Mar. 158(3):292-4. [Medline].

  6. Minchff TV. Early dislodgement of percutaneous and endoscopic gastrostomy tube. J S C Med Assoc. 2007 Feb. 103(1):13-5. [Medline].

  7. Kadakia SC, Cassaday M, Shaffer RT. Prospective evaluation of Foley catheter as a replacement gastrostomy tube. Am J Gastroenterol. 1992 Nov. 87(11):1594-7. [Medline].

  8. Kiatipunsodsai S. Gastrostomy Tube Replacement Using Foley's Catheters in Children. J Med Assoc Thai. 2015 Apr. 98 Suppl 3:S41-5. [Medline].

  9. Uflacker A, Qiao Y, Easley G, Patrie J, Lambert D, de Lange EE. Fluoroscopy-guided jejunal extension tube placement through existing gastrostomy tubes: analysis of 391 procedures. Diagn Interv Radiol. 2015 Nov-Dec. 21 (6):488-93. [Medline].

  10. Stogdill BJ, Page CP, Pestana C. Nonoperative replacement of a jejunostomy feeding catheter. Am J Surg. 1984 Feb. 147(2):280-2. [Medline].

  11. Burke DT, El Shami A, Heinle E, et al. Comparison of gastrostomy tube replacement verification using air insufflation versus gastrograffin. Arch Phys Med Rehabil. 2006 Nov. 87(11):1530-3. [Medline].

  12. Taheri MR, Singh H, Duerksen DR. Peritonitis after gastrostomy tube replacement: a case series and review of literature. JPEN J Parenter Enteral Nutr. 2011 Jan. 35(1):56-60. [Medline].

  13. Friedmann R, Feldman H, Sonnenblick M. Misplacement of percutaneously inserted gastrostomy tube into the colon: report of 6 cases and review of the literature. JPEN J Parenter Enteral Nutr. 2007 Nov-Dec. 31(6):469-76. [Medline].

  14. Fernandez-Pineda I, Sandoval JA, Jones RM, Boateng N, Wu J, Rao BN, et al. Gastrostomy Complications in Pediatric Cancer Patients: A Retrospective Single-Institution Review. Pediatr Blood Cancer. 2016 Mar 9. [Medline].

  15. Bumpers HL, Collure DW, Best IM, et al. Unusual complications of long-term percutaneous gastrostomy tubes. J Gastrointest Surg. 2003 Nov. 7(7):917-20. [Medline].

Previous
Next
 
Commonly used by radiologists, Cope loop catheters (illustrated with a metal introducer stiffener) are easily placed into the stomach. However, their small lumina and small side holes predispose them to catheter occlusion.
Commonly used for surgical, endoscopic, and radiologic gastrostomy access, balloon catheters provide secure intraluminal retention and are simple to place and replace.
When gastrostomy tubes are dislodged, the sinus tract (top right) can be readily identified and recanalized for up to several days. With sinus tracts of this diameter, feeding tubes can often be reinserted directly. When tracts are narrower, angiographic catheters and wires are often used, and tract dilatation may be necessary for tube replacement.
Regarding tube-site infections, most catheter-related infections involve local cellulitis, as shown here, with erythema and tenderness. These infections frequently respond to local wound care and oral antibiotics.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.