Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices

Table 1 Periprocedural pearls for gastrostomy tube placement

Recognize indications, relative contraindications, and absolute contraindications for gastrostomy tube placement

Ensure appropriate informed consent and discussion of the benefits of gastrostomy tubes

Ensure correct selection of gastrostomy technique:

Transoral techniques should be first line except in select indications where transabdominal techniques maybe more appropriate

Placement by radiology is appropriate when the endoscopist is not trained in the transoral or transabdominal technique necessary or lacks availability of materials

Laparoscopic tube placement should be utilized when endoscopic or radiographic gastrostomy fails or is contraindicated

Perform certain periprocedural interventions to reduce adverse events:

Physical exam for oropharyngeal and abdominal wall abnormalities, ascites, and obesity

Hold anticoagulation and antiplatelet therapy appropriately and correct coagulopathy to avoid bleeding

Administer antibiotic prophylaxis targeting skin flora thirty minutes prior to procedure to prevent infection

Drain ascites beforehand and avoid gastrostomy tube placement if fluid reaccumulation is expected to occur within 7-10 d

Obtain cross-sectional imaging (e.g., computed tomography) if colonic interposition and other suspected anatomical abnormalities are suspected

Use reverse Trendelenburg patient positioning, proper transillumination and palpation of anterior gastric wall, and use of safe track maneuver during initial needle puncture to prevent inadvertent liver or colonic puncture

Minimize external bumper traction and ensure tube is rotatable to prevent buried bumper syndrome and ulceration

Consider abdominal binders to restrict access, gastropexy devices, and low-profile gastrostomy button with detachable tubing to prevent patient tube dislodgement