You review a patient on the ward for abdo pain and pyrexia, and they have some sort of tube with feeds going into their stomach. You need to call the surgeons for a consult for their abdo pain. But what you call it? Do you know the difference between your PEGs and gastrostomies? Do you understand about tube calibres and lengths? In this four-part series, Camille Wu covers everything the general paediatrician needs to know about enteral feeding via gastrostomies….
See the other posts: Day 2 – types; Day 3 – devices; Day 4 – complications.
What is a gastrostomy?
“Gastrostomy” literally means “hole in the stomach”. This “hole” is then plugged with a device (so gastric contents don’t leak everywhere).
The device can be a low-profile “button”, or the classic tube.
When would you need a gastrostomy?
Generally, a gastrostomy replaces the function of a nasogastric tube (NGT).
Patients might need a NGT/gastrostomy for:
- feeding access (e.g. neurological dysfunction, impaired swallowing, inadequate oral intake, failure to thrive)
and /or
- gut decompression (e.g. gastroparesis/dysmotility or obstruction).
If the NGT is required for a prolonged period of time, it may be easier for the parents (and/or the patient) to have a gastrostomy instead.
What are the main pros and cons?
Benefits include:
- not having a tube stuck onto your face (cosmetic and comfort reasons)
- not having the tube irritating the back of your throat (many, but not all, children get used to this)
Disadvantages include:
- the “permanence” of the gastrostomy
- general anaesthesia that is required to insert, (and usually) to remove/close the gastrostomy
- the attendant complications of the procedure and of the device itself
