Gastrostomies

Jennifer Trust Information Information Sheet N° 014.
Gastrostomies

Gastrostomy is the name for the operation to place a feeding tube into the stomach. There are several types of feeding tube, the most commonly used are the PEG and the Mic-Key button, both are methods of providing nutrition directly into the stomach via a tube through the stomach wall. Commonly called a G-tube. Their use can be either to support a person who is unable to take in sufficient calories by mouth, or in some cases to completely remove the need for food or fluid by mouth.

Some people with neuromuscular (and other) conditions have difficulties with chewing and swallowing (dysphagia), this can sometimes lead to aspiration (food or drink 'going down the wrong way' - ending up in the lungs), and this can lead to bacterial infections and possibly pneumonia. If this is the case it may be necessary to avoid certain food & drink, or in some cases to cease oral feeding completely. This will be assessed by the health care team - usually using a videofluoroscopy (a method of filming and assessing the swallowing process)

A G-tube does not necessarily stay in forever and should the person's ability to safely take sufficient calories orally return, the gastrostomy can easily be removed and will quickly heal leaving only a very small scar.

PEG (Percutaneous Endoscopic Gastrostomy)

The PEG is a length of tube with a valve at the end, one end goes into the stomach the other end (a couple of inches long) stays outside the body, the valve is opened at feeding times and food is pumped through the tube directly into the stomach.

MIC-KEY BUTTON

Fundoplication

Some people may have a problem with stomach acids flowing back up from the stomach into the food pipe (oesophagus). This is called "gastro oesophageal reflux", frequently just referred to as "reflux". If this occurs along side the risk of aspiration (detailed above) a fundoplication may be recommended. A fundoplication is an operation to 'tie up' the neck of the fundus (opening into the stomach).

The need for this procedure is usually assessed using a PH test - a probe is inserted up the nose and into the stomach where over a 24 hour period the acidity/alkalinity is measured. This will tell the doctors if reflux is present and whether a fundoplication is needed or not.

A fundoplication is a much longer and more complex procedure than a gastrostomy and the need for it should be carefully considered and discussed with your doctor/surgeon. After a fundoplication it is unlikely that a person will be able to vomit, however with a gastrostomy the stomach can be emptied using the tube if they feel sick

Installing the G-Tube

Placing a G-tube is a surgical procedure usually requiring general anaesthetic and lasting about 20-30 minutes. (Occasionally the operation may be performed under sedation, although this is rare). The most common process is for the surgeon to pass a tube with a light at the end (an endoscope), through the mouth and into the stomach. The surgeon then locates the light through the skin and makes a small (pen sized) whole called a Stoma. In some circumstances (when there is curvature of the spine for example) the surgeon may use a tube with a camera attachment; this allows the surgeon to see inside the stomach, reducing the risk of 'nicking' any major organs. The G-tube is then placed through the Stoma directly into the stomach. The tube is usually held in place with a water filled balloon or a small disc.

This procedure is considered a minor operation, however all operations contain an element of risk; this risk is greater for people with neuromuscular conditions. The main element of risk is in relation to an anaesthetic and a potentially weakened respiratory system. It is important that these issues are fully discussed with appropriate health care professionals, before making a final decision to proceed with the procedure.

The operation usually requires hospitalisation for about a week, this is to give time to recover and also to get used to the gastrostomy. It sometimes takes a little while for the body to accept the G-tube and tolerate regular feeds. This will be monitored and assessed by the health care team.

Methods of delivering food

There are two method of pumping the feed through the G-tube: bolus feeds are pumped in using a large syringe, or slow continuous feeds can be delivered using a pump. Which type to use will really be down to the individual's ability to cope with a particular feeding regime and their lifestyle. Some people find bolus feeds difficult to accept and may prefer slow continuous feeds using a pump more suitable. This is often done overnight. For some people bolus feeds delivered by a syringe work better and can help maintain a feeling of regular mealtimes. Using syringe feeds also means that food can be provided when out and about more easily. (A syringe is much easier to transport than a pump).

The person using the G-Tube and a suitable healthcare practitioner, often a dietician will develop the most suitable feeding regime. It is important that that during this process the person's lifestyle is taken into account and that a suitable compromise between an appropriate feeding regime and day-to-day activities is found. It is also possible to change feeding regimes should one become no longer appropriate.

Types of feed

A dietician will also provide advice on the type of feed to be used; this will be a pre-prepared liquid that contains the correct mix of nutrients. Some feeds contain fibre so that if the person is unable to manage fruit and vegetables a healthy bowel can be maintained. It is important to stick to the prescribed diet, although liquid medicines may be passed though the tube, (make sure this is discussed with the dietician).

Some common questions

Will this hurt?
Discomfort/slight pain after the operation - soon passing

Will my child tolerate the feeds?
It is important to progress slowly especially if a person's stomach is not used to being full

Will my friends know its there?
Not if you don't want them too

Can I still go swimming?
Yes

Can it fall out?
This can happen (although rare), a nurse or doctor or even parents can pop it back, quickly and easily

Will I still be able to wear my Spinal Jacket?
Yes although it may require a simple adaptation (a hole for the tube)

Is it easy to keep clean?
Yes, just keep it clean with cotton wool & warm water

Some parents perspectives

"Mealtimes used to be a nightmare; watching every mouthful, never able to relax. Now she can eat as much as she is able and we can relax knowing that we can top-up her calories overnight."

"Since the gastrostomy she seems to have much more energy and more importantly has had fewer chest infections and coped better when she has. Although it did take her several months to get used to it and she had to be off school for a couple of months."

"It is the best thing we ever did, although we were scared before we are so happy we went ahead."

"He had his G-tube 6 months ago - he has gone from skeletal to positively squidgy."