Enteral nutrition delivers food, fluids, and medication directly into the gastrointestinal tract when a person cannot meet their nutritional needs by mouth. This process often involves placing a gastrostomy tube, commonly called a G-tube, which creates a path directly into the stomach. The variety of medical acronyms and terms used for these devices often causes confusion. The difference between a G-tube and a PEG tube is a frequent point of misunderstanding because one term is broad and the other is highly specific.
The Relationship Between G-Tubes and PEG Tubes
The term G-tube, short for Gastrostomy Tube, is the generic designation for any feeding tube that passes through the abdominal wall and terminates inside the stomach. This definition encompasses all devices providing long-term access to the stomach for nutritional support and creates a stoma, a small, surgically created opening on the abdomen.
A PEG tube, which stands for Percutaneous Endoscopic Gastrostomy tube, is a specific type of G-tube. The distinction lies entirely in the method used to insert the device, not in the tube’s final function or location. Every PEG tube is a G-tube, but not every G-tube is a PEG tube.
Understanding Tube Placement Methods
The procedure defining a PEG tube involves using an endoscope, a flexible tube with a camera and light, to guide placement. During the procedure, the endoscope passes through the mouth, down the esophagus, and into the stomach. The endoscope’s light helps the physician identify the optimal insertion point on the external abdominal wall.
The PEG method is considered less invasive than traditional surgical approaches because it avoids a large incision. The procedure often uses the “pull technique,” where a wire is passed into the stomach and snared by the endoscope. The feeding tube is then attached and pulled back through the abdomen to secure it in the stomach.
Other G-tubes are placed using different techniques, often requiring surgical intervention. Laparoscopic surgery involves several small incisions to insert instruments and a camera to visualize the stomach. This approach allows the surgeon to anchor the stomach wall to the abdominal wall with sutures, reducing the risk of internal leakage. Traditional open surgery (Stamm technique) involves a larger abdominal incision but is now less common. Another method is the Radiologically Inserted Gastrostomy (RIG), where a tube is placed under X-ray guidance by an interventional radiologist.
Common Types and Configurations
Once the gastrostomy tract, or stoma, has healed, the external hardware can vary significantly regardless of the initial placement method. The original PEG tube is typically a long, flexible tube extending several inches from the abdomen. It is secured internally by a bumper or disc and externally by a fixation device, but these standard tubes can be cumbersome and visible under clothing.
A common alternative is the low-profile gastrostomy device, often called a “button.” This device sits flush with the skin, making it less noticeable and more comfortable for active individuals. The button requires an attachable extension set for feeding or medication, which is disconnected when not in use. These devices are typically balloon-retained, held in place by a small balloon inflated with water inside the stomach. Low-profile buttons frequently replace the initial long tube once the stoma tract has fully matured, usually after several months.
Daily Care and Maintenance
Proper care of the gastrostomy site prevents complications and maintains skin integrity, regardless of whether it is a PEG tube or a button. The skin around the stoma must be cleaned daily with mild soap and water to remove drainage or crusting. Ensure the area is thoroughly dried after cleaning, as persistent moisture can lead to skin breakdown or fungal infections.
Tube patency is maintained by flushing the device with water before and after each feeding or medication administration. This prevents the accumulation of residue that could lead to a tube blockage. If using a long tube, it should be rotated a quarter turn daily to prevent the internal bumper from continuously pressing against the stomach lining. Caregivers should monitor the stoma for signs of infection, such as increased redness, swelling, or unusual discharge.