Gastrostomy

Gastrostomy is a procedure that establishes an opening from the abdominal wall directly into the stomach (a stoma) to allow access for enteral feeding, administration of medications, or, in some cases, gastric decompression. It is typically used when long-term oral intake is not possible or safe.

Several techniques exist. The most common is percutaneous endoscopic gastrostomy (PEG), in which a feeding tube is placed through the skin into the stomach under endoscopic guidance. Other methods include radiologically inserted gastrostomy (RIG) and surgical gastrostomy. Modern devices include external bumpers or low-profile buttons anchored to the skin.

Indications include prolonged inability to swallow or tolerate oral nutrition due to neurologic disease (for example stroke, amyotrophic lateral sclerosis, cerebral palsy), head and neck malignancies, advanced dementia, severe gastroesophageal obstruction, or prior esophageal damage. The goal is reliable, safe, long-term enteral nutrition or medication delivery.

Procedure and care: placement is performed under appropriate anesthesia or sedation with guidance dependent on the chosen method. After placement, the tube is secured, and feeding may begin according to protocol once initial healing has occurred. Care involves regular cleaning of the skin, flushing the tube with water, and monitoring for dislodgement, blockage, or leakage. Nutritional formulas or medications are delivered via the tube.

Complications may include infection at the stoma, tube dislodgement or blockage, leakage around the stoma, skin irritation, and buried bumper syndrome. Less common risks include peritonitis and gastrocolic fistula. The tube can be removed or replaced when no longer needed or if failure occurs, with appropriate medical oversight.