How is a gastrostomy tube replacement performed?

Updated: May 26, 2020
  • Author: Erik D Schraga, MD; Chief Editor: Vikram Kate, MBBS, MS, PhD, FRCS, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

Once the tube has been removed, replacement should occur as soon as possible to prevent tract narrowing and closure. If a similar G-tube will not pass through the tract or cannot be found, place a smaller tube or a Foley catheter to keep the tract open. A more permanent tube can be placed at a later time.

Before replacing the G-tube, assess the tract (see the image below). Gently dilating the ostium and probing the tract with a cotton swab or hemostat may increase the ease of tube passage. Aggressive probing should be avoided, as a false tract can be created.

When gastrostomy tubes are dislodged, the sinus tr When gastrostomy tubes are dislodged, the sinus tract (top right) can be readily identified and recanalized for up to several days. With sinus tracts of this diameter, feeding tubes can often be reinserted directly. When tracts are narrower, angiographic catheters and wires are often used, and tract dilatation may be necessary for tube replacement.

Once the tract has been assessed, lubricate the tube, and slide it gently into the tract. If a mushroom is present and does not slide through the ostomy easily, elongate the mushroom by placing a stylet or Kelly clamp through a side hole into the mushroom tip. Never force the tube; doing so can lead to a false tract or separation of the stomach from the external stoma.

Aspiration of gastric contents or ultrasound examination can be carried out to confirm the placement of the tube in the stomach. Secure the tube and obtain a confirmation study (see below).

If a specialized G-tube is not obtainable, a Foley catheter may be used temporarily to prevent tract closure until a G-tube becomes available. [8] A large study described the placement of Foley catheters in children and found this procedure to be safe, with no severe complications. [9] However, complications have been reported, such as catheter traction into the duodenum leading to gastric outlet obstruction. [10]

To prevent ingress of the Foley catheter into the ostomy, use an external bolster that can be tied to the skin. To create the bolster, cut a 3-cm segment of tubing from a catheter. Then, bend the tubing in half and cut on each side of the catheter to create two holes. Insert a hemostat through the two holes, grab the catheter, and pull the catheter through.

Before inserting the Foley catheter, check the balloon to ensure its integrity. Lubricate the distal catheter and tract opening, then slide the Foley catheter down the tract. Confirm the placement, as mentioned above. If the placement is deemed correct, inflate the balloon with saline, and use gentle traction to draw the balloon to the stomach wall. Push the bolster down to the abdominal wall, and suture in place 1 cm from the external abdomen. Overly tight bolsters can result in a short stoma and abscess formation.

In rare cases, Foley catheter migration leading to compression necrosis of mucosa by the balloon leading to perforation can occur. [11] External tube fixation should be carried out firmly to prevent this complication.

If G-tube replacement does not occur easily, abort the procedure, and contact the provider who placed the tube. An interventional radiologist may also be contacted to advance the tube over a wire under fluoroscopic guidance. For more information, see Percutaneous Gastrostomy and Jejunostomy. A procedure whereby jejunal extension tubes are placed through previously placed gastrostomy tubes under fluoroscopic control has also been described. [12]

In pediatric patients who present with dislodged G-tubes, serial dilatation of the tube stoma site has been found to allow successful replacement with minimal complications. [13]


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