A feeding gastrostomy is a medical procedure that creates a small opening, known as a stoma, directly into the stomach through the abdominal wall. A feeding tube, commonly called a G-tube, is then inserted into this opening to facilitate the delivery of nutrients, fluids, and medications. This method is a form of enteral nutrition, providing a crucial lifeline for those who cannot consume adequate nourishment by mouth. Unlike temporary solutions like nasogastric (NG) tubes, a gastrostomy is designed for long-term use, offering a more stable and comfortable alternative.
The Primary Uses for a Feeding Gastrostomy
A feeding gastrostomy serves as a vital intervention for individuals with functional digestive systems but who face significant barriers to oral intake. The decision to place a G-tube is made by a multidisciplinary medical team, considering the patient's specific health condition and nutritional status.
Specific Indications for Gastrostomy Use
- Neurological disorders: Conditions that impair swallowing, such as stroke, cerebral palsy, amyotrophic lateral sclerosis (ALS), Parkinson's disease, and multiple sclerosis, are common reasons for requiring a feeding gastrostomy. In these cases, it helps prevent aspiration pneumonia, a dangerous complication caused by food or liquid entering the lungs.
- Head and neck cancers: Patients undergoing treatment for these cancers, such as radiation or chemotherapy, often experience difficulty swallowing (dysphagia) or extreme fatigue. A G-tube ensures they receive consistent nutrition to support recovery and maintain strength.
- Gastrointestinal disorders: Individuals with conditions affecting the esophagus or stomach, such as esophageal strictures or congenital anomalies, may require a gastrostomy to bypass the affected area.
- Failure to thrive: Children who struggle to gain weight or grow normally due to underlying health issues may be candidates for a G-tube to supplement their oral intake with additional calories and nutrients.
- Chronic illness: Some patients with chronic illnesses, including cystic fibrosis, may require supplemental nutrition to meet increased energy demands.
Types of Gastrostomy Tubes
The type of G-tube used depends on the patient's needs and anatomical considerations. They are typically inserted using one of three main procedures: percutaneous endoscopic gastrostomy (PEG), radiologically inserted gastrostomy (RIG), or surgical placement.
- Standard PEG Tube: A flexible tube held in place by an internal bumper and an external fixator. It extends from the abdomen and can be concealed under clothing.
- Low-profile Gastrostomy Button: A small, discrete device that sits flush with the skin, often preferred for active patients or children. An extension set is attached for feeding and then removed afterward.
- Gastrojejunostomy (GJ) Tube: A variation where the tube is threaded through the stomach and extends into the jejunum, the second part of the small intestine. This is used for patients who cannot tolerate feeds in the stomach.
Feeding Methods and Nutritional Management
Dietitians develop a personalized nutrition plan based on the patient's needs. The feeding regimen can be delivered in a couple of ways:
- Bolus Feeding: Involves administering a larger volume of formula over a shorter period, often to mimic mealtimes. This method typically relies on gravity using a syringe.
- Continuous Feeding: Delivers a smaller amount of formula over a longer duration, usually using an enteral pump. This is common for patients who do not tolerate larger volumes at once.
Nutritionally, specialized liquid formulas provide all necessary macro- and micronutrients. In some cases, with strict medical oversight, a blended diet of home-prepared foods may be an option, but it requires powerful blenders and careful preparation to ensure proper consistency and prevent tube blockage.
Comparison: Gastrostomy Tube vs. Nasogastric (NG) Tube
| Feature | Gastrostomy Tube (G-tube) | Nasogastric Tube (NG-tube) |
|---|---|---|
| Usage Period | Long-term (more than 4-6 weeks) | Short-term (up to 4-6 weeks) |
| Placement | Surgically or endoscopically through the abdominal wall into the stomach | Inserted through the nose, down the esophagus, into the stomach |
| Comfort and Visibility | Generally more comfortable and less visible for long-term use | Can cause nasal irritation and is more visible externally |
| Risk of Dislodgement | Lower risk of accidental dislodgement once the tract is mature | Higher risk of displacement, potentially into the lungs |
| Aspiration Risk | Lower risk of aspiration compared to NG tubes for patients with dysphagia | Higher risk, especially for patients with severe swallowing issues |
Potential Complications and Management
While gastrostomy feeding is safe and effective, complications can arise. Proper care and monitoring are essential to minimize risks.
- Infection: Redness, warmth, swelling, or yellow/green drainage around the stoma site can indicate an infection. Daily cleaning with soap and water is crucial.
- Peristomal Leakage: Leakage of stomach contents or formula can irritate the skin. This may be due to a poor-fitting tube or pressure on the site.
- Tube Blockage: This can happen if the tube is not flushed properly after feedings or medications. Flushing with warm water can help clear the blockage.
- Buried Bumper Syndrome: A serious, late complication where the internal bumper of the tube erodes into the stomach wall. Regular tube rotation (if not stitched) helps prevent this.
- Granulation Tissue: Over time, pink, fleshy tissue can grow around the stoma. It is common and usually only requires treatment if it becomes painful or leaks.
Conclusion
In summary, a feeding gastrostomy is a critical medical intervention used to provide long-term nutritional support for patients with impaired oral intake but otherwise functioning digestive systems. For individuals with neurological disorders, certain cancers, and chronic illnesses, a G-tube ensures adequate hydration and nutrition, significantly enhancing their health and quality of life. While requiring diligent daily care and monitoring for complications, it is a highly effective solution that allows patients and their families to manage nutritional needs with greater safety and comfort than short-term alternatives like NG tubes. The decision to proceed with a feeding gastrostomy is an important one, always made in consultation with a medical team to ensure it aligns with the patient's overall care goals and long-term prognosis.
For more detailed information on living with and caring for a gastrostomy, visit the Great Ormond Street Hospital website.
