Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices

Abstract

Gastrostomy tube placement is a procedure that achieves enteral access for nutrition, decompression, and medication administration. Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events (AEs). Appropriate indications, contraindications, ethical considerations, and comorbidities of patients referred for gastrostomy placement should be weighed and balanced. Additionally, endoscopist should consider either a transoral or transabdominal approach is appropriate, and radiologic or surgical gastrostomy tube placement is needed. However, medical history, physical examination, and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.

Keywords: Gastrostomy; Gastropexy; Enterostomy; Decompression; Enteral nutrition; Endoscopy

Core Tip: We reviewed 179 articles and compiled suggested considerations, especially for endoscopists, in the preprocedural evaluation of gastrostomy candidates. Patients referred to for gastrostomy tube placement should be evaluated for indications, contraindications, ethical considerations, and comorbidities. Additionally, the proceduralist should consider whether radiologic or surgical tube placement may be more appropriate, and whether a transoral or transabdominal approach is appropriate. Prior to the procedure, physical examination, imaging, and other interventions should be performed to reduce adverse events.