A gastrostomy status refers to having a gastrostomy, which is a surgically created opening (stoma) through the abdominal wall directly into the stomach. This opening provides a path for a specialized feeding tube, commonly called a G-tube, for the delivery of nutrition, fluids, and medications. The tube provides enteral access, ensuring a person receives adequate sustenance when they are unable to safely or sufficiently eat by mouth. While the G-tube is often associated with long-term nutritional support, it can also be used for gastric decompression, which involves venting air or draining stomach contents.
Conditions Requiring a Gastrostomy
The decision to place a gastrostomy tube is made when a patient cannot maintain sufficient oral intake, typically for a period expected to exceed four weeks. A common cause is severe dysphagia (difficulty swallowing), which prevents food from safely reaching the stomach and poses a risk of aspiration into the lungs. Neurological conditions frequently lead to this swallowing impairment, including disorders such as stroke, Parkinson’s disease, or amyotrophic lateral sclerosis (ALS).
Other indications involve physical obstructions or conditions that increase nutritional requirements or prevent eating. Patients undergoing treatment for head and neck cancers may require a G-tube due to tumor obstruction or the side effects of radiation and chemotherapy, which make swallowing painful or impossible. For infants and children, a gastrostomy may be necessary for congenital anomalies of the upper gastrointestinal tract, severe failure to thrive, or complex chronic illnesses.
Placement Procedures and Tube Types
Gastrostomy tube placement is typically performed using minimally invasive techniques, with the Percutaneous Endoscopic Gastrostomy (PEG) method being the most common approach. During a PEG placement, an endoscope is passed through the mouth to visualize the stomach interior, allowing the surgeon to select the precise site for the stoma on the abdominal wall. The tube is then inserted through a small incision and secured inside the stomach with an internal bumper and externally with a fixation plate.
Alternative methods include surgical placement, often preferred in patients with complex abdominal anatomy, or radiologically guided insertion. Gastrostomy tubes come in two main forms: the standard PEG tube, which is a longer, more visible tube, and the low-profile device, often called a “button.” The button is a shorter device that sits flush against the skin, offering greater discretion and mobility, and is generally placed after the initial stoma tract has fully healed.
Routine Care and Administration
Daily care of a gastrostomy site is necessary to prevent infection and maintain tube function. The skin around the stoma, known as the peristomal area, should be cleaned once or twice daily with mild soap and water, then patted dry. Ensure the external fixator or button is not pressing too tightly against the skin, as this can lead to irritation or the development of granulation tissue.
A routine flushing protocol is followed to prevent the tube from becoming clogged, typically using 15 to 60 milliliters of water before and after each use. Feeds can be administered in several ways, including a continuous infusion via an electronic pump over many hours, or in larger amounts, known as bolus feeding, using a syringe. Medications must be crushed and dissolved completely in water before administration through the tube, followed by an additional flush to clear the line.
Long-Term Status and Quality of Life
The duration of gastrostomy status varies significantly; the tube may be temporary for some patients, while others require it permanently. Common long-term issues include skin irritation, leakage of stomach contents around the tube, and the formation of hypergranulation tissue at the stoma site. Patients and caregivers are trained to monitor the site for signs of infection, such as redness or excessive drainage, and to manage minor complications at home.
For many individuals, the gastrostomy allows for a return to normal activities, including bathing and swimming once the site is fully healed. While a G-tube helps maintain nutritional status, the impact on health-related quality of life varies depending on the underlying condition. By ensuring adequate nutrition and hydration, the gastrostomy allows patients to focus on their overall health and manage their primary medical condition.