Gastrostomy

Definition
Purpose
Demographics
Description
Preparation
Aftercare
Risks
Normal results
Morbidity and mortality rates
Alternatives

Definition

Gastrostomy is a surgical procedure for inserting a tube through the abdomen wall and into the stomach. The tube, called a “g-tube,” is used for feeding or drainage.

Purpose

Gastrostomy is performed because a patient temporarily or permanently needs to be fed directly through a tube in the stomach. Reasons for feeding by gastrostomy include birth defects of the mouth, esophagus, or stomach, and neuromuscular conditions that cause people to eat very slowly due to the shape of their mouth or a weakness affecting their chewing and swallowing muscles.

Gastrostomy is also performed to provide drainage for the stomach when it is necessary to bypass a longstanding obstruction of the stomach outlet into the small intestine. Obstructions may be caused by peptic ulcer scarring or a tumor.

Demographics

In the United States, gastrostomies are more frequently performed on older individuals.

Description

Gastrostomy, also called gastrostomy tube (g-tube) insertion, is surgery performed to give an external opening into the stomach. Surgery is performed either when the patient is under general anesthesia or under local anesthesia.

Fitting the g-tube usually requires a short surgical operation that lasts about 30 minutes. During the surgery, an opening (stoma) about the diameter of a small pencil is cut in the skin and into the stomach; the stomach is then carefully attached to the abdominal wall. The g-tube is then fitted into the stoma. It is a special tube held in place by a disc or a water-filled balloon that has a valve inside allowing food to enter, but nothing to come out. The hole can be made using two different methods. The first uses a tube called an endoscope that has a light at the end, which is inserted into the mouth and fed down the esophagus and into the stomach. The light shines through the skin, showing the surgeon where to perform the incision. The other procedure does not use an endoscope. Instead, a small incision is made on the left side of the abdomen; an incision is then made through the stomach. A small, flexible, hollow tube, usually made of polyvinyl chloride or rubber, is inserted into the stomach. The stomach is stitched tightly around the tube, and the incision is closed.

The length of time the patient needs to remain in the hospital depends on the age of the patient and the patient’s general health. In some cases, the hospital stay can be as short as one day, but often is longer. Normally, the stomach and abdomen heal in five to seven days.

The cost of the surgery varies, depending on the age and health of the patient. Younger patients are usually sicker and require more intensive, and thus more expensive, care. The procedure is normally covered by medical insurance.

KEY TERMS

Anesthesia— A combination of drugs administered by a variety of techniques by trained professionals that provide sedation, amnesia, analgesia, and immobility adequate for the accomplishment of a surgical procedure with minimal discomfort, and without injury to the patient.

Endoscopy— A procedure in which an instrument containing a camera is inserted into the gastrointestinal tract so that the doctor can visually inspect the gastrointestinal system.

Preparation

Before the operation, the doctor will perform an endoscopy and take x rays of the gastrointestinal tract. Blood and urine tests will also be performed, and the patient will meet with the anesthesiologist to evaluate any special conditions that might affect the administration of anesthesia.

Aftercare

Immediately after the operation, the patient is fed intravenously (through a vein) for at least 24 hours. Once bowel sounds are heard, indicating that the gastrointestinal system is working, the patient can begin clear liquid feedings through the tube. The volume of the feedings is gradually increased.

Patient education concerning use and care of the gastrostomy tube is very important. Patients and their families are taught how to recognize and prevent infection around the tube, how to insert food through the tube, how to handle tube blockage, what to do if the tube pulls out, and what normal activities can be resumed.

Risks

There are few risks associated with this surgery. The main complications are infection, bleeding, dislodgment of the tube, stomach bloating, nausea, and diarrhea.

Gastrostomy is a relatively simple procedure. As with any surgery, however, patients are more likely to experience complications if they are smokers, obese, use alcohol heavily, or use illicit drugs. In addition,

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

The procedure is performed at a hospital or surgical clinic by a surgeon or gastroenterologist trained in endoscopy and placement of these tubes.

some prescription medications may increase risks associated with anesthesia.

Normal results

The patient is able to eat through the gastrostomy tube, or the stomach can be drained through the tube.

Morbidity and mortality rates

The mortality rate of people who have had a gastrostomy is relatively high, however, the cause of death is almost always related to the illness or conditions that necessitated the insertion of the tube rather than to the actual surgical procedure.

Alternatives

There are no alternatives to a gastrostomy because the decision to perform it is made when a person is unable to take in enough calories to meet the demands of the body.

Resources

PERIODICALS

Angus, F., and R. Burakoff. “The Percutaneous Endoscopic Gastrostomy Tube. Medical and Ethical Issues in Placement.” American Journal of Gastroenterology 98 (February 2003): 272–277.

Pontieri-Lewis, V. “Basics of Ostomy Care.” MedSurg Nursing 15 no. 4 (August 1, 2006): 19—203.

ORGANIZATIONS

American College of Gastroenterology. P.O. Box 342260 Bethesda, MD 20827-2260. (301) 263-9000. http://www.acg.gi.org (accessed March 31, 2008).

American Gastroenterological Association (AGA). 4930 Del Ray Avenue, Bethesda, MD 20814. (301) 654-2055. http://www.gastro.org (accessed March 31, 2008).

United Ostomy Association of America. (UOAA). P. O. Box 66, Fairview, TN 37062-0066 (800) 826-0826. http://www.uoaa.org (accessed March 31, 2008).

QUESTIONS TO ASK THE DOCTOR

• What happens on the day of surgery?
• What type of anesthesia will be used?
• What happens after g-tube insertion?
• What are the risks associated with the procedure?
• How is the g-tube insertion done?
• Will there be a scar?
• Will I be able to eat normal food?
• Will people notice that I have a g-tube?
• Will it be there forever?

OTHER

“Feeding Tube Insertion.” Medline Plus. December 13, 2006 [cited January 5, 2008]. http://www.nlm.nih.gov/medli-neplus/ency/article/002937.htm (accessed March 31, 2008).

Tish Davidson, AM

Monique Laberge, PhD

GE surgery seeGastroenterologic surgery

General anesthetia seeAnesthesia, general