Title

Gastrostomy Feeding Tubes

Authoring Organization

American Society for Gastrointestinal Endoscopy

Publication Month/Year

November 7, 2024

Last Updated Month/Year

December 2, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for strategies to manage endoscopically placed gastrostomy tubes. This document was developed using the Grading of Recommendations Assessment, Development and Evaluation framework. The guideline addresses the utility of percutaneous endoscopic gastrostomy (PEG) versus interventional radiology–guided gastrostomy (IR-G), need for withholding antiplatelet and anticoagulant medications before PEG tube placement, appropriate timing to initiate tube feeding after PEG, and selection of the appropriate technique of gastrostomy in patients with malignant dysphagia. In patients needing enteral access, the ASGE suggests PEG as the preferred technique for initial gastrotomy over IR-G. The ASGE recommends that tube feeding can be safely started within 4 hours of gastrostomy. The ASGE suggests that PEG can be performed without withholding antiplatelet medications. The ASGE suggests that the periprocedural management of anticoagulants should be based on a multidisciplinary discussion regarding the risk of bleeding versus cardiovascular events. In patients with malignant dysphagia, either transoral “pull” PEG or direct PEG can be performed for initial enteral access.

Health Care Settings

Hospital, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D005774 - Gastrostomy

Keywords

Gastrostomy, feeding tubes

Source Citation

ASGE Standards of Practice Committee; Kohli DR, Abidi WM, Cosgrove N, Machicado JD, Desai M, Forbes N, Marya NB, Thiruvengadam NR, Thosani NC, Alipour O, Ngamruengphong S, Elhanafi SE, Sheth SG, Ruan W, Fang JC, McClave SA, Zvavanjanja RC, Kamel AY, Qumseya BJ. American Society for Gastrointestinal Endoscopy guideline on gastrostomy feeding tubes: summary and recommendations. Gastrointest Endosc. 2024 Nov 7:S0016-5107(24)03505-3. doi: 10.1016/j.gie.2024.08.044. Epub ahead of print. PMID: 39520459.