Gastrostomy tube (G tube)

A gastrostomy tube is a soft plastic tube that passes through a small opening in the upper left belly straight into the stomach. You may also hear it called a G tube, or a PEG when it is placed with an endoscope. We place ours with X-ray guidance, sometimes called a radiologic gastrostomy.

Inside the stomach, a small balloon filled with water keeps the tube from slipping out. Outside, a flat disc called a bolster or flange rests on the skin and keeps the tube snug. The outer end has ports for feeding and medicines.

On the X-ray screen, the stomach looks like a dark air-filled bubble. A little contrast dye through the new tube outlines the stomach folds in white, which confirms that the tip is in the right place.

All three methods work well. The best choice depends on your anatomy, other procedures you may need and local expertise. A thin tube through the nose, called a nasogastric tube, is an option for short-term feeding but is uncomfortable to keep for more than a few weeks.

The procedure is done at El Camino Hospital. Two nurses, a technologist and your interventional radiologist care for you, and your heart rate, blood pressure and oxygen are watched throughout.

1. 1
   Relaxing and preparing

   Moderate sedation through your IV helps you relax. A thin tube is passed through your nose into your stomach.

2. 2
   Filling the stomach with air

   Air is gently pumped into your stomach through the nose tube. This pushes the stomach up against the belly wall and makes it easy to see on X-ray.

3. 3
   Anchoring the stomach

   After numbing the skin, we place 2 to 4 small anchors called T-fasteners. They hold the stomach wall against the belly wall while it heals.

4. 4
   Placing the tube

   Between the anchors, a needle enters the stomach and a guidewire is passed. The opening is gently widened and the G tube slides in over the wire. The balloon is filled with water.

5. 5
   Checking and finishing

   Contrast dye confirms the position. The outer disc is snugged to the skin, and the nose tube is removed. The whole procedure takes about 30 minutes.

1. First hour
   You recover while the nurses check your site and vital signs. Family can join you.
2. Rest of the day
   Clear liquids by mouth only, if you are allowed to eat. The tube is not used yet. No driving if you had sedation.
3. Next day
   If your belly is not very painful, start using the tube as instructed and slowly return to your usual diet. You may shower.
4. First week
   Soreness fades over 2 to 3 days. No heavy lifting or strenuous activity for about 1 week.
5. 1 to 4 weeks
   The T-fasteners fall off on their own. Throw them away. If they are still there after 2 to 3 weeks, we can remove them in clinic.

If a tube is not flushed well, formula and medicine build up inside it and harden. A clogged tube cannot be used for food or medicine, and it often has to be replaced.

The biggest problem I see with new G tubes is not a complication of the procedure. It is a tube that clogs in the first few weeks because it was not flushed. I ask every patient and caregiver to flush before and after everything that goes in, and to call early if the tube feels tight, before it blocks completely.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos

Image-guided G tube placement is safe for most people. Serious complications are uncommon. The most common problems are minor: soreness, some leakage and skin irritation.