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Gastrostomy Tube Placement

Last updated March 21, 2018

Approved by: Krish Tangella MD, MBA, FCAP

A gastrostomy tube is a tube inserted through the abdomen (typically under the left rib cage) into the stomach. It is most commonly used to deliver nutrition, directly to the stomach.


Background Information:

What are the other Names for the Procedure?

  • G Tube Placement
  • Gastric Feeding Tube Placement
  • Janeway Gastrostomy

What is the Gastrostomy Tube Placement surgical procedure?

  • A gastrostomy tube is a tube inserted through the abdomen (typically under the left rib cage) into the stomach
  • It is most commonly used to deliver nutrition, directly to the stomach
  • Sometimes, it can be used to drain stomach secretions by connecting to a bag

What part of the Body does the Procedure involve?

The Gastrostomy Tube Placement (or G Tube Placement) procedure involves the:

  • Stomach
  • Abdominal wall

Why is the Gastrostomy Tube Placement surgical procedure Performed?

The Gastrostomy Tube Placement procedure is performed for the following reasons:

  • Babies with birth defects of the mouth, esophagus, or stomach
  • Sucking and swallowing disorders, which are often related to prematurity, brain injury, developmental delay, or certain neuromuscular conditions, such as severe cerebral palsy
  • Failure to thrive, which is a general diagnosis that refers to a child's inability to gain weight and grow appropriately
  • Extreme difficulty taking medicines
  • Patients, who cannot take enough food by mouth to stay healthy
  • Advanced dementia, where patients may not be able to feed themselves
  • Patients with the eating disorder anorexia nervosa may be tube fed, if they are significantly malnourished
  • Conditions that lead to blockage of the upper portion of the small intestine resulting in bile and acid accumulation in the stomach, typically leading to periodic vomiting

What are some Alternative Choices for the Procedure?

  • Total parenteral nutrition may be considered wherein the nutrition is given through the veins.  But, due to the side effects involved, ‘nutrition via gut’ is considered better than ‘nutrition via veins’, particularly when long-term nutrition is planned
  • Feeding jejunostomy tube is an acceptable alternative, wherein the nutrition is given on the jejunum (a portion of small intestine few inches below the stomach) 

What are the Recent Advances in the Procedure?

Laparoscopic and PEG Tube Placements are advancements in the procedure compared to open technique.

What is the Cost of performing the Gastrostomy Tube Placement surgical procedure?

The cost of Gastrostomy Tube Placement procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Gastrostomy Tube Placement procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://kidshealth.org/parent/system/surgery/g_tube.html# (accessed on 10/19/2014)

http://www.nlm.nih.gov/medlineplus/ency/article/002937.htm (accessed on 10/19/2014)

http://www.cincinnatichildrens.org/health/g/g-tube-care/ (accessed on 10/19/2014)

http://www.medicalhomeportal.org/clinical-practice/technology-reviews/gastrostomy (accessed on 10/19/2014) 

Prior to Gastrostomy Tube Placement surgical procedure:

How is the Gastrostomy Tube Placement surgical procedure Performed?

The three methods for inserting a G-tube are:

  • Percutaneous (through the skin) Endoscopic Gastrostomy (PEG)
  • Laparoscopic technique (Janeway Gastrostomy)
  • Open surgical procedure (Stamm Gastrostomy)

PEG Tube Placement:

  • It is the most common technique used
  • An endoscope (a thin, flexible tube with a tiny camera and light at the tip) is inserted through the mouth and into the stomach to guide the doctor's positioning of the G-tube
  • After the endoscopy tube is inserted, the skin over the left side of belly (abdomen) area is cleaned and numbed
  • The doctor makes a small surgical cut in this area and inserts a small, flexible, hollow tube with a balloon or special tip into the stomach
  • Surgical incision around the tube is closed with sutures

Laparoscopic G Tube Placement:

  • Using a narrow tube-like instrument (cannula), the surgeon enters the abdomen in the area of the belly button
  • A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient's internal organs on a television screen
  • Other cannulas are inserted which allow the surgeon to pass other instruments
  • An opening is made on the stomach and the G tube is passed from the outside through the abdominal wall and then inserted into the stomach
  • The tube is then secured to the stomach with sutures placed on the stomach around the tube
  • The stomach is then anchored to the abdominal wall from inside with sutures placed laparoscopically
  • After placement of the tube, the small incisions are closed with 1-2 stitches, or using surgical tape

Open Gastrostomy Tube Placement:

  • This procedure is usually reserved for cases where the anatomy does not allow for a PEG; if there is scar tissue from a previous surgery, procedure, or illness, or in case the patient requires another surgical procedure at the same time
  • An incision is made in the upper abdomen and the abdominal cavity entered
  • The stomach is identified and an appropriate location selected, on the wall of the stomach
  • An opening is made on the stomach and the G tube is passed from the outside through the abdominal wall and then inserted into the stomach
  • The tube is then secured to the stomach with sutures placed on the stomach around the tube
  • The stomach is then anchored to the abdominal wall from the inside with sutures
  • The upper abdominal incision is then closed with sutures

Where is the Procedure Performed?

The Gastrostomy Tube Placement procedure is performed in a hospital. The patient is admitted, undergoes the procedure and is discharged as per the instruction of the physician.

Who Performs the Procedure?

The Gastrostomy Tube Placement procedure is generally performed by a physician trained in general surgery, with assistance from an anesthesiologist.

How long will the Procedure take?

The G Tube Placement procedure may take anywhere between 30 minutes to an hour.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Gastrostomy Tube Placement procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Gastrostomy Tube Placement procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Gastrostomy Tube Placement surgical procedure?

  • The tests for a Gastrostomy Tube Placement procedure vary according to the cause/reason for performing the procedure
  • Sometimes, an x-ray of the upper gastrointestinal (GI) system may be performed, which allows the physician to see a portion of the digestive system

What are some Questions for your Physician?

Some basic questions to ask the physician are:

  • What is the Gastrostomy Tube Placement surgical procedure?
  • Why is this procedure necessary? How will this procedure help?
  • What does the procedure involve?
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • What are the risks while performing the procedure?
  • What are the possible complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Gastrostomy Tube Placement surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the Gastrostomy Tube Placement procedure, the following anesthesia may be considered:

  • General anesthesia (asleep and pain-free)
  • The procedure can also be performed under local anesthesia (PEG Tube Placement in particular) and medicine to relax (awake, but pain-free)

How much Blood will you lose, during the Procedure?

The amount of blood loss is generally minimal (especially with PEG Tube Placement, or when the procedure is performed laparoscopically). However, if complications arise during the procedure, it could lead to a further loss of blood.

What are the possible Risks and Complications during the Gastrostomy Tube Placement surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Gastrostomy Tube Placement procedure are:

  • Infection
  • Bleeding
  • Injury to the neighboring structures
  • Pain and/or discomfort
  • Anesthetic complications
  • Need for further procedures
  • Pneumonia
  • Blood clot formation
  • Heart problems
  • Tube dislodgement

What Post-Operative Care is needed at the Healthcare Facility after the Gastrostomy Tube Placement surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Gastrostomy Tube Placement surgical procedure:

What are the possible Risks and Complications after the Gastrostomy Tube Placement surgical procedure?

Post Gastrostomy Tube Placement procedure, the following complications may arise:

  • Infection
  • Bleeding
  • Discomfort and pain
  • Need for further procedures
  • Pneumonia
  • Tube dislodgement

What is the Prognosis after the Surgery?

  • The gastrostomy site can be prone to infection and irritation, so it must be kept clean and dry; frequent hand washing is a must
  • Fortunately, most complications can be quickly and successfully treated when discovered early
  • Once the site heals, patients who have had a gastrostomy, have very few (if any) restrictions related to the tube
  • Some patients might worry about how the tube looks and how others might react. If this happens, ask your doctor to recommend a social worker, who can be of assistance

After a few months, the physician may recommend replacing the longer tube with a mic-key "button" - a device that is flatter and lies against the skin of the abdomen.

  • This can often be done without surgery in the doctor's office, unless advised otherwise
  • The button can be opened for feedings and closed in between feedings or medications
  • For many families, the transition to a button makes tube feedings and care easier and more convenient
  • If and when the doctor decides that the patient is able to take in enough nutrition by mouth, the G-tube or button may be removed
  • Removal takes only minutes and is usually done in the office by the physician or nurse

Once the button or G-tube is removed, a small hole will remain which should be kept clean and covered with gauze, until it closes on its own. In some cases, surgery is necessary to close the hole. Either way, the scar that remains is usually small in size.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Pain that worsens and swelling (and redness) around the surgical wound
  • Bleeding or fluid drainage from the surgical wound
  • Fever
  • Dizziness
  • Signs of infection
  • Dislodged tube
  • Blocked or clogged tube
  • Severe abdominal pain
  • Persistent vomiting or diarrhea
  • Trouble passing gas or having a bowel movement
  • Pink-red tissue (called granulation tissue) coming out from around the g-tube

What Post-Operative Care is needed at Home after the Gastrostomy Tube Placement surgical procedure?

The patient or family of the patient will be taught:

  • How to care for the skin around the tube
  • How to observe for any signs and symptoms of infection
  • What to do if the tube is pulled out? This is important because if the tube falls out of place, the hole can begin to close
  • Signs and symptoms of tube blockage
  • How to empty the stomach through the tube
  • How to hide the tube under clothing
  • What normal activities may be undertaken
  • How and what to feed through the tube

Following a Gastrostomy Tube Placement, the post-operative care required at home includes:

  • Feeding should be started slowly with liquids and gradually advanced as the patient’s tolerance level increases
  • You might hear feedings being referred to as "bolus" or "continuous”. Bolus feedings are larger and less frequent (more like a regular meal)
  • Continuous feedings, which often take place overnight, are delivered by a pump to patients who need smaller, slower feedings
  • A nutritionist will help plan and schedule a specific diet based on the patient’s needs
  • Patients who have a G-tube are not necessarily unable to also eat by mouth. Although the tube feedings can be used to replace all oral feedings; in some cases, the tube supplements what a patient eats by mouth
  • If your doctor decides that the patient is physically able to eat, the medical team will help teach the skills needed for independent eating

How long does it normally take to fully recover, from the Procedure?

It takes anywhere between 1-2 weeks to fully recover from the Gastrostomy Tube Placement procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Gastrostomy Tube Placement procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Gastrostomy Tube Placement surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital
  • The general surgeon
  • An anesthesiologist (if anesthesia was administered)

The patient is advised to inquire and confirm the type of billing, before the Gastrostomy Tube Placement procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Dec. 12, 2014
Last updated: March 21, 2018