Treatment of Gastrostomy

Introduction

Gastrostomy is a medical procedure used to create an opening through the abdomen directly into the stomach. This opening called a gastrostomy tube (G-tube) allows doctors to deliver nutrition, fluids, and medicines to patients who cannot eat or swallow normally. The treatment of gastrostomy involves deciding the right type of tube, performing the procedure safely, managing recovery, and ensuring long-term care. In this detailed guide, we explain treatment of gastrostomy is done, who needs it, benefits, risks, and how to care for a G-tube effectively.

What Is Gastrostomy?

Gastrostomy is a surgical or endoscopic technique used to insert a feeding tube directly into the stomach. It is typically recommended when a patient has difficulty swallowing or cannot meet their nutritional needs through regular oral intake. The opening created the stoma acts as a channel through which food and medicines can be delivered easily and safely.

Common terms associated with gastrostomy include

1. PEG (Percutaneous Endoscopic Gastrostomy) inserted using an endoscope
2. Surgical Gastrostomy performed through open or laparoscopic surgery
3. Radiologic Gastrostomy (RIG) guided by imaging techniques

Each type is selected based on the patient’s condition, overall health, and urgency of feeding support.

Who Needs a Gastrostomy?

Doctors recommend gastrostomy for patients who are unable to swallow or digest food properly due to medical conditions such as

1. Stroke or severe neurological disorders
2. Head and neck cancers
3. Esophageal disorders
4. Advanced dementia
5. Long-term unconsciousness or coma
6. Congenital abnormalities in children
7. Chronic aspiration risk

For patients who require long-term nutritional support, gastrostomy offers a safe and reliable alternative to nasogastric (NG) tube feeding.

Types of Gastrostomy Tubes

Choosing the right G-tube is an important part of gastrostomy treatment. The commonly used types include

1. PEG Tubes :- The most widely used method, PEG tubes are placed using an endoscope. This method is minimally invasive, less painful, and suitable for most patients needing long-term feeding.
2. Balloon Gastrostomy Tubes :- These tubes have a balloon on the internal end that holds the tube securely inside the stomach. They are easier to replace and often used in ongoing care.
3. Button Gastrostomy Tubes :- Also known as low-profile devices, these tubes sit flush with the skin surface and are more comfortable for children and active adults.
4. Surgical Gastrostomy Tubes :- Used when the stomach cannot be accessed endoscopically. This method is performed using traditional open surgery or laparoscopy.

How Is Gastrostomy Performed?

The gastrostomy procedure differs depending on the method chosen, but the steps generally include

1. Pre-Procedure Evaluation :- Doctors assess

• Current nutritional status
• Swallowing ability
• Digestive health
• Risk of aspiration

Blood tests, imaging studies, and medical clearance are performed before the procedure.

2. Sedation and Preparation :- Patients are usually given a light sedative and local anesthesia. In children or those requiring surgical gastrostomy, general anesthesia may be used.
3. Tube Insertion

• In PEG, the endoscope is passed through the mouth into the stomach.
• A small incision is made in the abdomen.
• The feeding tube is gently drawn through and secured.

The entire procedure typically takes 20–30 minutes.

4. Post-Procedure Observation :- Patients are monitored for a few hours to ensure there is no bleeding, infection, or breathing difficulty. Feeding through the tube may begin within 12–24 hours.

Benefits of Gastrostomy

Gastrostomy offers numerous advantages, especially for patients with long-term feeding difficulties

1. Reliable Nutrition Delivery :- Ensures the patient receives adequate calories, vitamins, and minerals essential for recovery and growth.
2. Reduced Aspiration Risk :- Lower risk of food entering the lungs compared to oral or NG tube feeding.
3. Improved Quality of Life :- Patients feel more comfortable, experience fewer feeding interruptions, and can continue normal daily activities.
4. Better Long-Term Feeding Solution :- More stable and secure than nasogastric tubes, which can slip or cause irritation in the throat and nose.

Recovery and Aftercare

Proper care after gastrostomy is crucial to avoid complications and ensure the tube functions smoothly.

1. Stoma Care

• Keep the insertion site clean and dry.
• Clean the skin around the tube with mild soap and water once daily.
• Rotate the tube gently to prevent skin tissue from growing around it.

2. Feeding Care :- Patients usually receive

• Liquid formulas
• Water flushes to prevent clogging
• Scheduled feeding cycles based on doctor recommendations

A dietician may guide caregivers on formula type and feeding schedule.

3. Tube Maintenance

• Flush the tube before and after every feeding.
• Check balloon volume (for balloon tubes) weekly.
• Replace the tube as per manufacturer or doctor guidelines.

Possible Risks and Complications

Although gastrostomy is safe, some complications can occur. Common issues include

1. Infection :- Redness, swelling, or discharge around the stoma may indicate infection. Proper cleaning and early treatment prevent worsening.
2. Blocked Tube :- Solid medicines or thick formulas may clog the tube. Regular flushing helps avoid this problem.
3. Leakage :- Leakage of stomach fluids around the stoma can irritate the skin. Correct tube positioning usually resolves this.
4. Tube Displacement :- Accidental pulling may dislodge the tube. Immediate medical attention is required, especially for new stomas.
5. Buried Bumper Syndrome :- Rare but serious, this occurs when the internal bumper becomes embedded in the stomach wall. Early signs include pain or difficulty with feeding.

When to Seek Medical Help

Seek immediate help if the patient experiences

1. Severe abdominal pain
2. Fever or sudden swelling
3. Continuous leakage
4. Bleeding from the stoma
5. A displaced feeding tube

Timely medical attention prevents further complications.

Conclusion

The treatment of gastrostomy plays a vital role in supporting patients who cannot take food orally. Whether it is PEG, radiologic, or surgical gastrostomy, the procedure ensures safe and reliable nutrition with long-term benefits. With proper care, most patients adapt well and regain strength.