Sometimes, a person can’t get all the nutrition they need by eating. When that happens, they might need enteral nutrition. Enteral nutrition is a way to deliver nutrients directly to the digestive system via a feeding tube.
There are several different types of feeding tubes. Two common options are gastric tubes (G-tubes) and percutaneous endoscopic gastrostomy (PEG) tubes.
A gastric tube is any feeding tube that goes directly into the stomach. A PEG tube is a specific type of G-tube that’s placed using a special procedure called an endoscopy.
This article will explain the differences between a gastric tube vs. a PEG tube. We’ll look at when each one is used, how they’re placed, and the pros and cons of each.
It’s important to understand the differences between these two types of tubes so you can make informed decisions about your care. While we’re focusing on G-tubes and PEG tubes, it’s worth noting that other types of feeding tubes exist, like nasogastric (NG) tubes, nasojejunal (NJ) tubes, and jejunostomy tubes. These tubes are inserted through the nose or a surgical opening into the small intestine.
Types of Gastric Feeding Tubes
There are several different types of gastric feeding tubes. Here’s a rundown:
Gastric Tubes (G-tubes)
A gastric tube, or G-tube, is a feeding tube that goes directly into your stomach. G-tubes are often placed surgically at the same time as other abdominal procedures.
The surgeon may use either open surgery or a laparoscopic approach to place the G-tube.
Percutaneous Endoscopic Gastrostomy (PEG) Tubes
A percutaneous endoscopic gastrostomy, or PEG tube, is a G-tube that’s placed using an endoscope (a long, thin, flexible tube with a camera on the end). The surgeon makes a small incision in your abdomen, then uses the endoscope to guide the PEG tube into your stomach.
Low-Profile Gastrostomy Devices
A low-profile gastrostomy device, sometimes called a “button,” is a type of G-tube that lies flat against your skin, making it less noticeable and, for some people, more comfortable. Because it sits close to the body, it’s less likely to get caught on clothing or dislodged.
It’s important to select the correct size of low-profile device to avoid complications. These devices use an internal balloon or a “mushroom” bolster to keep the tube in place.
How are PEG tubes and surgical G-tubes placed?
There are a couple of different ways to insert a tube for long-term feeding. Let’s take a look at the two most common.
Percutaneous Endoscopic Gastrostomy (PEG) Placement
With this procedure, the surgeon threads an endoscope (a long, thin, flexible tube with a camera and light at the end) down your throat and into your stomach. You’ll be given sedation and a local anesthetic to keep you comfortable during the procedure.
The surgeon then makes a small cut in your abdomen. Using the video from the endoscope as a guide, the surgeon pushes the PEG tube through the abdominal wall and into your stomach. Then, the endoscope is removed, leaving the PEG tube in place.
PEG placement is minimally invasive, which means there’s generally a lower risk of complications compared to a more involved surgical procedure.
Surgical G-Tube Placement
In this procedure, the surgeon creates an opening in your stomach and inserts the G-tube through that opening. This can be done through traditional open surgery or laparoscopically, using small incisions and specialized instruments.
Surgical placement is preferred in certain situations, such as if you’re already having abdominal surgery for another reason or if you have a medical condition that makes endoscopy too risky.
What to consider for both procedures
Before either procedure, your doctor will explain the risks and benefits, and you’ll need to give your informed consent. You’ll also have a thorough medical evaluation to make sure you’re a good candidate for the procedure.
Afterward, it’s important to follow your doctor’s instructions carefully for post-procedure care and to watch for any signs of complications, such as infection or bleeding.
When do doctors recommend gastric tubes?
Doctors will typically recommend a gastric tube when someone can’t get enough nutrition by mouth. There are several reasons that can happen:
- Trouble swallowing. Conditions like dysphagia, stroke, and head and neck cancer can make it difficult to swallow food safely.
- Neurological disorders. Neurological conditions such as cerebral palsy and amyotrophic lateral sclerosis (ALS) can weaken the muscles needed for chewing and swallowing.
- Gastrointestinal disorders. Gastroparesis and bowel obstructions can interfere with digestion and nutrient absorption, sometimes requiring a gastric tube for decompression or feeding.
- Malnutrition. If someone isn’t getting enough nutrients, a feeding tube can help them get the nutrition they need.
- Before and after surgery. Doctors sometimes use feeding tubes to make sure people are in the best nutritional shape possible before and after major surgeries.
Advantages and Disadvantages
Both PEG tubes and surgically placed G-tubes have their own set of pros and cons. The best choice for you or your loved one will depend on your specific medical situation, your doctor’s expertise, and your preferences.
PEG Tubes
Advantages
- Minimally invasive, so there’s less trauma to your body.
- Placement is usually pretty quick.
- General anesthesia isn’t always needed. Sometimes, the procedure can be done with local anesthetic and sedation.
Disadvantages
- Risk of infection at the spot where the tube goes in.
- The tube can sometimes get pulled out or dislodged.
- If the stomach isn’t properly attached to the abdominal wall during the procedure, there’s a risk of peritonitis, a serious inflammation of the abdominal lining.
- Requires a doctor who’s skilled in endoscopy.
Surgical G-Tubes
Advantages
- Can be done at the same time as other abdominal surgeries, if needed.
- May be a better option if there are reasons why an endoscopy can’t be performed.
Disadvantages
- More invasive than a PEG tube placement.
- Generally a higher risk of complications compared to PEG tubes.
- Requires general anesthesia, which always carries some risk.
- Longer recovery time than with a PEG tube.
Comparison Table
Here’s a quick look at the advantages and disadvantages of each type of tube:
| Feature | PEG Tube | Surgical G-Tube |
|---|---|---|
| Invasiveness | Minimally Invasive | More Invasive |
| Anesthesia | Local/Sedation or General | General |
| Complication Risk | Lower | Higher |
| Recovery Time | Shorter | Longer |
Potential Complications
Like any medical procedure, G-tube and PEG tube placement carry some risks. These include:
- Infection: Infections can occur at the insertion site. Peritonitis, a serious infection of the abdominal lining, is also a risk.
- Tube dislodgement: It’s essential to know how to recognize and deal with a dislodged tube. If a tube has been in place for more than a month, a mature tract has probably formed. If a PEG tube has been in place for less than four weeks, the stomach may not have adhered to the abdominal wall. If the tube comes out, the stomach can fall away from the abdominal wall.
- Leakage: Fluid can leak around the insertion site.
- Bleeding: Bleeding can occur during or after the procedure.
- Aspiration pneumonia: There’s a risk of food or liquid entering the lungs, leading to pneumonia. Prevention strategies are crucial.
- Buried bumper syndrome: This occurs when the internal bumper of the tube migrates into the abdominal wall. Knowing how to prevent it is important.
- Bowel perforation: There’s a small risk of accidentally puncturing the bowel during tube placement.
When are post-pyloric feeding tubes necessary?
Most of the time, feeding tubes deliver nutrition directly into the stomach. But sometimes, doctors need to bypass the stomach and deliver nutrition directly into the small intestine. These tubes are called post-pyloric tubes.
Post-pyloric feeding is often used when the stomach doesn’t empty properly (gastroparesis), when something is blocking food from leaving the stomach, or when a patient is at high risk of aspirating food into their lungs.
There are several types of post-pyloric tubes. The most common are gastro-jejunostomy tubes (PEG-J or G-J tubes) and jejunostomy tubes (PEJ or J-tubes).
Some surgeries, such as gastrectomy (removal of part or all of the stomach) or esophagectomy with gastric pull-up (removal of the esophagus with the stomach pulled up to replace it), may require a post-pyloric feeding tube.
PEG-J vs. PEJ: What’s the difference?
A PEG-J tube is a gastro-jejunostomy tube. It’s placed through the abdominal wall, into the stomach, and then threaded into the jejunum (the middle part of the small intestine).
A PEJ tube is a jejunostomy tube. It’s placed directly into the jejunum.
So, what are the pros and cons? PEG-J tubes can be useful because they allow for both gastric and jejunal feeding. However, they’re more complex to place and maintain. PEJ tubes are simpler, but only allow for jejunal feeding.
Research indicates that PEG-J tubes have higher re-intervention rates than PEJ tubes. One study found that, over six months, 56% of PEG-J patients needed another intervention, compared to only 13.5% of PEJ patients. This suggests that PEG-J placement is more complicated and prone to issues.
How to care for a feeding tube
Whether you have a G-tube or a PEG tube, it is important to clean the skin around the insertion site every day and change any dressings. Your doctor will give you detailed instructions.
Flushing the tube with water regularly is also crucial to prevent clogs. Again, follow your doctor’s recommendations.
You’ll also need to watch for signs of complications, such as infection, leakage, or the tube coming out. Contact your doctor right away if you notice these.
Different types of feeding tubes need to be replaced on different schedules. For example, PEG tubes with an internal balloon need to be replaced every four months.
It’s essential that both patients and caregivers understand how to manage the feeding tube properly. Ask your medical team to explain everything clearly.
Summary
As we’ve seen, both G-tubes and PEG tubes provide a way to deliver essential nutrition directly to the stomach, but they differ in placement and the procedure used to insert them. G-tubes are typically placed surgically, while PEG tubes are inserted endoscopically. This difference in insertion method can influence factors like recovery time and suitability for certain patients.
Choosing between a G-tube and a PEG tube is a decision that should be made carefully, with the patient’s specific needs and medical condition in mind. It’s important to consider the patient’s overall health, nutritional requirements, and any preferences they may have regarding the method of insertion and tube management.
Regardless of which type of tube is chosen, proper care and monitoring are essential to prevent complications such as infection, blockage, or skin irritation. With proper management, these tubes can play a vital role in providing the nutritional support that patients need to maintain their health and well-being.