Gastrostomy Tube Replacement

A gastrostomy tube (G-tube) is indicated for long-term enteral nutritional support in patients with dysphagia secondary to various disorders. Endoscopic gastrostomy tube placement is now the preferred modality over surgical gastrostomy owing to its less invasive nature and a shorter time to initiation of feeding. During endoscopic gastrostomy tube placement, a small incision is made over the anterior abdominal wall through which the tube is placed via a push method (the tube is inserted percutaneously through the incision) or a pull technique (the tube is pulled out from the stomach through the incision). Once the tube is placed, a fistulous gastrocutaneous tract is formed in about 2-4 weeks. However, in certain conditions, such as severe malnutrition, immunocompromised patients, and large ascites, tract maturity is further delayed. If a percutaneous gastrostomy endoscopic (PEG) tube is dislodged within a month after placement, then endoscopic replacement is recommended. However, if the tube is dislodged after 4 to 6 weeks when tract maturity is expected, bedside replacement is usually sufficient. If the tube is dislodged within 4 weeks of initial placement, patients are at significant risk of peritonitis and perforation due to peritoneal spillage of gastric contents through the immature track, and replacement should not be attempted without surgical consultation. A blind attempt to re-insert the tube or even foley placement in an immature tract can lead to inadvertent placement of the tube into the peritoneal cavity. In this review article, we discuss the replacement of the Gastrostomy tube in adult patients with complete maturation of the gastrocutaneous tract.