Placing feeding tubes

• This is a percutaneous endoscopic gastrostomy. The child is given an anesthetic or is sedated during the procedure.
• An endoscope is passed down the child’s throat and all the way into the stomach.
• The doctor makes an incision (stoma) into the stomach and a thread is inserted into the stoma, then pulled back through the child’s throat and out the mouth.
• The feeding tube (PEG tube) is tied onto the thread and pulled out through the opening in the stomach wall (stoma).
• The tube has a disc that prevents the tube from pulling all the way out of the stoma.
• A bumper or disc is attached to the tube from outside the body to help stabilize the tube and work with the internal disc to keep the stomach wall tight against the abdomen.
• Most often the tube can be used for feeding the same day.
• Healing is quick – there is one small incision.
• The PEG method can not be performed on all children.

• A surgical gastrostomy may be required if a scope can not be easily passed to the stomach, the abdomen is already surgically opened for another procedure, or the doctor finds that the position of the bowel will impede the insertion of the tube through the PEG route.
• The surgical method makes two incisions (cuts).
• The surgeon puts a tube with a balloon or mushroom-shaped bulb at one end and into the stomach through the larger incision.
• The other end is pulled through the second small incision (stoma) and the tube is secured.
• The stomach is stitched to the abdominal wall.
• The bulb/balloon helps prevent the tube from falling out.
• A Foley catheter, Malecott catheter, Bard button, MIC KEY button or MIC G tube are examples of  tubes that may be used in a surgical gastrostomy.

• This is a minimally invasive approach to inserting a gastrostomy tube using an endoscope called a laparoscope.
• Often a skin level device or a MIC G tube is placed as the primary tube.
• There will be two small incisions at the umbilicus (belly button).

• This surgical method requires two abdominal incisions. They are made a small distance apart.
• The surgeon creates an opening into the jejunum through the first and larger incision.
• A feeding tube is placed into the jejunum and the tube is pulled through the other incision  – a MIC jejunostomy tube or a Foley are used to access this site (as a feeding tube).
• The jejunum is stitched against the abdominal wall and the larger incision is closed.
• A stitch may be put in to secure the tube to the skin to hold the tube in place during the healing phase.

• This is another type of jejunostomy.
• The surgeon takes a portion of the jejunum and creates a short blind-ending limb into which the tube is inserted for the JT.
• There is one incision, and a separate opening for the JT (usually a MIC G).
• A skin level device may be inserted after three months.

Braun-type jejunostomy

• Information to follow 

Transgastric feeding tube (GJ)

• This is a feeding tube that goes into the jejunum (small bowel) through an already established (more than 6 weeks) gastrostomy.
• The tube is guided into place with the help of x-ray type images that show up on a special screen.
• The tube is inserted by the radiology department - insertion/reinsertion is arranged through the radiology department.