eMedicine Specialties > Clinical Procedures > Gastrointestinal Procedures

Gastrostomy Tube Replacement

Author: Suzanne M Miller, MD, Senior Resident, Department of Emergency Medicine, Stanford Hospital and Clinics
Coauthor(s): Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Contributor Information and Disclosures

Updated: Jul 23, 2008

Introduction

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 rate. 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

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 prior to ED replacement, as operative or fluoroscopic replacement may be required.

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 assess if nonoperative ED tube replacement can proceed safely.
  • Replacement should not be performed if any evidence of infection, such as extensive erythema, exudate, or warmth, is appreciated around the G-tube site.

More on Gastrostomy Tube Replacement

Overview: Gastrostomy Tube Replacement
Treatment & Medication: Gastrostomy Tube Replacement
References
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References

  1. Galat SA, Gerig KD, Porter JA, et al. Management of premature removal of the percutaneous gastrostomy. Am Surg. Nov 1990;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. Jan 1985;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. Nov 24 2006;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. Aug 2007;106(8):685-9. [Medline].

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

  6. Minchff TV. Early dislodgement of percutaneous and endoscopic gastrostomy tube. J S C Med Assoc. Feb 2007;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. Nov 1992;87(11):1594-7. [Medline].

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

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

  10. 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. Nov-Dec 2007;31(6):469-76. [Medline].

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

  12. Samuels LE. Nasogastric and feeding tube placement. In: Roberts JR, Hedges RJ. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, Pa: WB Saunders Company; 2004:41.

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Further Reading

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Keywords

gastrostomy tube, g tube, g-tube, G-tube, G-tube replacement, feeding tube, G-tube placement, feeding tube placement, emergency g-tube replacement, dislodged G-tube, gastrostomy, Witzel tunnel, tract, peritoneal cavity, balloon rupture, Foley catheter, Foley, foley, catheter, balloon catheter, external bolster, de Pezzer catheter, mushroom catheter, internal bolster, tract narrowing, tract closure, ostium, false tract, placement confirmation, confirm tube placement, borborygmi, bolster, fluoroscopic guidance, guide wire, Gastrografin, gastrografin, tube misplacement

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Contributor Information and Disclosures

Author

Suzanne M Miller, MD, Senior Resident, Department of Emergency Medicine, Stanford Hospital and Clinics
Suzanne M Miller, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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