Pediatric Gastrostomy (G-Tube) for Intestinal Transplant Patients

What Is Gastrostomy?

A gastrostomy is a surgical procedure used to insert a tube, often referred to as a "G-tube", through the abdomen and into the stomach. Gastrostomy is used to provide a route for tube feeding if needed for four weeks or longer, and/or to vent the stomach for air or drainage. Children may have this procedure if they are in need of an intestine transplant or after intestinal transplantation.

If your child is unable to eat enough food by mouth or needs extra calories to grow, a gastrostomy can help him get the nutrition he needs. A gastrostomy can also act as a drainage tube to bypass an obstruction, so that your child's stomach does not accumulate acid and fluids. Sometimes, when a patient cannot tolerate a nasogastric tube (or NG-tube, which reaches the stomach through the nose), doctors use a gastrostomy instead to drain and empty the stomach after surgery.

A gastrostomy may be in place permanently or only temporarily. It is considered a more long-term method of alternate feeding than NG- or nasojejunal (NJ) tube feeding. (NJ-tube feeding also goes through the nose, but instead of the stomach it goes into the part of the intestine just after the stomach – the jejunum.) However, once your child is able to eat safely and to eat enough by mouth to keep up his nutrition, surgeons may remove the gastrostomy tube.

Gastrostomy Procedure: What to Expect

A gastrostomy is a somewhat simple procedure. A surgeon and a gastroenterologist (a physician who specializes in the digestive system) work together to place the G-tube.

There are two methods used to perform a gastrostomy: the percutaneous endoscopic gastrostomy (PEG), and an open surgical procedure. Anesthesia prevents pain during the procedure. The type of procedure your child will be having will determine the type of anesthesia he or she receives.

PEG is the most common way to insert a G-tube, and is less invasive than open abdominal surgery. "Percutaneous" means "through the skin," and "endoscopic" means "internal examination with a tube". Your child will be awake while the doctors place his tube. Before the gastrostomy, your child will receive a local anesthetic (usually a lidocaine spray), an intravenous (IV) pain reliever, and a mild sedative. The sedative is given so that your child will not feel too nervous, and will be able to stay still throughout the procedure. Although your child may feel slight discomfort, the PEG is not painful.

Doctors guide a gastroscope (a type of endoscope, which is a long, thin tube with a light and camera at the end) through the mouth, down the throat, and into the stomach. Air is injected into the tube to stretch and enlarge the stomach. The doctors look through the lighted gastroscope into the stomach. The camera on the end of the scope produces pictures of the inside of the stomach on a video monitor. The scope helps the doctors decide where to make the incision, a small cut on the left side of the abdomen and into the stomach, where they will place the tube.

The area incision will be made is numbed with local anesthesia. A needle is inserted through the skin and abdominal wall and into the stomach. A thin guide wire is passed through this needle and into the stomach. The wire is secured and the needle is removed. Then the wire is pulled out with a wire snare through the mouth. Now, there is a thin wire entering the front of the abdomen into the stomach and continuing up and out of the mouth. The PEG feeding tube is attached to this wire outside of the mouth. The surgeon then pulls the wire back out from the abdomen, feeding the tube down into the body through the mouth and esophagus. The tube is pulled until the tip of the g-tube comes out of the incision in the stomach. There is a soft, round "bumper" attached to the part of the tube that remains in the body. The bumper secures the tube on the inside of the body. The outer portion of the tube is secured with a bumper also. Sterile gauze is placed around the incision site. Once the tube is in place, the stomach is deflated and the scope is removed. The PEG tube is secured to the abdomen with tape.

Most PEG procedures take 30–45 minutes and require no stay in the hospital. Patients receiving a PEG tube usually return home the same day, unless they are in the hospital for treatment of another condition.

The open surgical procedure requires general anesthesia, which means that your child will not be awake when the tube is placed. A G-tube is not usually placed this way, unless your child is having other stomach surgery at the same time, or if he or she cannot tolerate an endoscopy (having a long, thin tube guided through the mouth, down the throat, into the stomach).

The surgeon begins by making a small incision or cut through the skin, abdominal wall and, once in the body, another one into the stomach. A tube is placed through the skin and into the stomach, and is stitched into place. The surgeon then closes the incision.

What to Expect Before a Gastrostomy

The doctor may perform tests to see how well your child is able to swallow, and/or take x-rays of the gastrointestinal tract (stomach and intestines). Your child may have an internal examination of her stomach done with an endoscope before the G-tube is actually placed.

Your child's stomach should be as empty as possible before receiving the gastrostomy. The night before, make sure he or she eats a light meal at dinner and does not eat or drink anything after midnight, unless told otherwise by your doctor. Bring soft, comfortable changes of clothing to the hospital.

What to Expect after a Gastrostomy

Before it is used for feeding, the doctor may take an X-ray to make sure that the G-tube is in the correct place.

For a couple of days after the procedure, your child may have minor pain and soreness at the incision site. It may feel like a pulled muscle. Your doctor can prescribe pain medications to relieve any discomfort. He or she may need to be fed with intravenous (IV) fluids for the first day or two after G-tube placement. Once the doctor makes sure your child's stomach and intestines are ready, your child will be started on clear liquids, and gradually advanced to thicker liquids and solid foods through the G-tube as tolerated. It is a good idea for your child to upright – sitting or standing – for 30–60 minutes after eating. The foods your child is receiving now are generally pre-prepared, and are sold commercially. A dietician will help with a specific diet based on your child's nutritional needs. Depending on the reason for the tube and your doctor's recommendation, your child may still be able to have regular food and drink by mouth. Even if this is not the case, your child will not lose sensations of hunger or fullness while using a G-tube.

Before leaving the hospital, you and your child (if he or she is old enough), will learn how to care for the tube, administer feedings, and check for problems. Your healthcare provider's job is to make sure that you feel comfortable enough to do these things on your own, at home. He or she will physically show you what to do, step by step. Don't hesitate to call if you run into any additional questions about G-tube care once you and your child are home. You may want to have a nurse come to your home and help until you are comfortable with the feedings.

Gastrostomy and G-Tube Complications

Complications are not common during either type of gastrostomy procedure. Once the tube is in place and your child has recovered from the procedure, he or she can usually return to his or her normal activities. Still, it is important to stay on the lookout for complications, so that they can be addressed right away if they do occur.

Sometimes the G-tube is accidentally dislodged, most commonly during the first two weeks after its placement. Call the doctor right away if this happens, as the hole in the stomach where the G-tube is located heals very quickly. If the G-tube falls out, it needs to be put back in as soon as possible so that the hole in the stomach will not close up. This will prevent the need for another surgery.

It is very important to keep the area around the G-tube clean to prevent infection. Always wash your hands before touching the area around the G-tube, and remember the signs and symptoms of infection, so that you can look for and recognize them if they appear. These include fever and chills. If your child does pick up an infection and antibiotics are prescribed, make sure he or she takes all pills if antibiotics are ordered, even if he or she feels healthy. Keep the tube insertion site dry by changing the sterile gauze pads regularly, and taking care of the skin around the tube.

Most G-tubes leak a small amount; this is normal. The fluid that leaks out from the stomach can irritate the skin around the tube, so when you are cleaning the leaks it is a good idea to apply a bit of protective cream. A tube that leaks more than a little probably needs replacing because the balloon is leaking or it is not the correct size. Your child's doctor can give advice and help solve the problem. Sometimes a little blood leaks out as well. This is not uncommon either, but you should contact your child's doctor right away if the bleeding is profuse or does not stop.

Also be sure to call your doctor if your child experiences:

  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site around the G-tube
  • Blockage or clogging in the tube
  • A cough, shortness of breath, chest pain, or severe nausea or vomiting
  • An inability to pass gas or have a bowel movement
  • Severe abdominal pain and cramping
  • New abdominal swelling
  • Headaches, muscle aches, dizziness, or general ill feeling

Learn about other Intestinal Transplant Procedures.