Gastrostomy

Definition

Surgical or percutaneous creation of an opening (stoma) in the stomach wall to allow direct tube feeding, used for long-term enteral nutrition support. It bypasses normal oral intake and esophageal transit.

How it works

Gastrostomy is indicated when enteral nutrition support is needed for more than 4 weeks, offering greater comfort and fewer complications than nasogastric tubes. It can be placed percutaneously (PEG) using endoscopy or surgically (open gastrostomy). The procedure creates a permanent or semi-permanent stoma that allows direct access to the stomach for nutrient delivery. Patients can resume some oral intake if swallowing returns, and the tube can be removed if feeding is no longer needed with proper closure of the stoma.

Role

Provides long-term enteral nutrition while allowing comfortable, safe feeding and potential for swallowing rehabilitation in neurological or structural dysphagia.

Examples

• Amyotrophic lateral sclerosis (ALS) patients
• Dementia with severe swallowing dysfunction
• Chronic stroke rehabilitation
• Head and neck cancer patients

Recommendations

Ensure proper tube placement verification before first feed. Maintain stoma hygiene to prevent infection and granulation. Monitor for tube obstruction and replace every 3-6 months. Consider swallowing rehabilitation when appropriate.

Key takeaway

Gastrostomy is the preferred long-term enteral feeding method, offering comfort and better quality of life compared to nasogastric tubes.

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