Gastrostomy is a procedure during which a plastic feeding tube is inserted directly into the intestinal tract to provide nourishment when normal nutrition is difficult or impossible. Gastrostomy may conducted during an endoscopy, when the surgeon has inserted a tube through the nose down into the stomach, or through an incision in the skin that penetrates the abdominal wall. Patients using a feeding tube are said to be undergoing gavage or enteral feeding.
Reasons for Gastrostomy
A gastrostomy is often performed on patients who are under intensive care for a prolonged period or for one of the following reasons:
- Extremely premature birth
- Congenital defects of the mouth, esophagus, or stomach
- Eating disorders
- Failure to thrive or malnutrition
- Inability to swallow correctly
- Neurological or neuromuscular disorders
- Digestive disorders or diseases
- Advanced dementia
- Allergic disorders
Types of GastrostomyThere are three major types of gastrostomy, as listed below, each subcategorized by both the feeding tube's point of entry and its targeted area. Even when the procedure is performed through an abdominal incision, an endoscopy is normally part of the process. By enabling the surgeon to view the digestive tract through the use of tiny cameras, the scope helps to ensure that the feeding tube is correctly positioned.
Transnasal Endoscopic Gastrostomy
Most commonly, a gastrostomy tube is inserted through the nose during an endoscopy. The procedure is referred to by where the tube is attached in the intestinal tract as nasogastic, nasoduodenal or nasojejunal. Nasogastrostomies are commonly performed on infants and small children.
Percutaneous Endoscopic Gastrostomy
During a percutaneous endoscopic gastrostomy, a PEG tube enters the abdomen through an incision in the skin. Although most gastrostomies are performed as temporary procedures, in some cases the gastrostomy tube may remain in the patient as a long-term solution to a nutritional problem.
There are cases in which a traditional open surgery may be performed to insert a feeding tube. This procedure requires a larger abdominal incision and a longer period of recovery.
Risks of Gastrostomy
While a gastrostomy is considered routine and uneventful, there are risks associated with any surgical procedure. The risks of a gastrostomy may include the following:
- Displacement of the gastric tube
- Bloating, nausea, or diarrhea
- Breathing problems, particularly aspiration pneumonia
- Excessive bleeding
- Blood clot
- Adverse reactions to anesthesia or medications
- Post-surgical infection at the incision site
- Damage to adjacent organs
- Hernia at the incision site
Recovery After Gastrostomy
When a gastrostomy is performed, the stomach and abdomen usually heal in about a week. At first, the patient is fed intravenously. Once normal bowel sounds are heard, the patient is fed through the tube. Portions are gradually increased as the patient recovers. Moderate pain will be treated with pain medication and the patient will be taught how to take care of the feeding tube and to spot indications of possible infection or blockage. Many patients are able to lead relatively normal lives with a gastrostomy tube. In some cases, a gastrostomy tube must remain in place in order for the patient to survive.