Gastrostomy Tube Recommendations for Malnourished Patients

Indications for G-tube Placement

A gastrostomy (G) tube should be recommended for malnourished patients when enteral nutrition is required for more than 4-6 weeks and the patient has a functional gastrointestinal tract but cannot meet nutritional requirements orally, as recommended by the European Society for Clinical Nutrition and Metabolism 1, 2
G-tube placement should be considered when oral intake is absent or likely to be absent for 5-7 days, with earlier intervention needed in already malnourished patients, according to the European Society for Clinical Nutrition and Metabolism 3
G-tube is indicated when oral intake will be inadequate (<50% of requirements) for more than 7 days, as stated by the American Society for Parenteral and Enteral Nutrition 4, 5
Long-term enteral nutrition (>4 weeks) necessitates placement of a percutaneous tube such as percutaneous endoscopic gastrostomy (PEG), as recommended by the American Society for Parenteral and Enteral Nutrition 4, 6

Neurological disorders of swallowing (stroke, multiple sclerosis, motor neurone disease, Parkinson's disease, cerebral palsy) may require G-tube placement, as suggested by the European Society for Clinical Nutrition and Metabolism 2
Cognitive impairment and depressed consciousness (head injury) may also require G-tube placement, according to the European Society for Clinical Nutrition and Metabolism 2
Long-term partial failure of intestinal function requiring supplementary intake (short bowel, fistulae) may necessitate G-tube placement, as recommended by the European Society for Clinical Nutrition and Metabolism 2

The patient's gastrointestinal function must be adequate to absorb and tolerate the proposed feeding, as stated by the European Society for Clinical Nutrition and Metabolism 2
Ethical issues must be considered, and G-tube placement must be in the patient's best interest, according to the European Society for Clinical Nutrition and Metabolism 3

Intestinal obstruction or ileus are contraindications to G-tube placement, as stated by the American Society for Parenteral and Enteral Nutrition 8
Severe shock is a contraindication to G-tube placement, according to the American Society for Parenteral and Enteral Nutrition 8
Intestinal ischemia is a contraindication to G-tube placement, as recommended by the American Society for Parenteral and Enteral Nutrition 8

For patients requiring long-term enteral nutrition (>4 weeks), PEG placement is recommended, as stated by the American Society for Parenteral and Enteral Nutrition 4, 6
In post-surgical patients not tolerating oral intake, enteral nutrition should be considered within 1-2 days of surgery in severely malnourished patients, according to the European Society for Clinical Nutrition and Metabolism 3

For short-term feeding (<4 weeks), nasogastric tubes are appropriate, as recommended by the European Society for Clinical Nutrition and Metabolism 1, 2
Nasojejunal tubes or needle catheter jejunostomy should be considered for patients undergoing major upper gastrointestinal and pancreatic surgery, according to the American Society for Parenteral and Enteral Nutrition 6

Start tube feeding with a low flow rate (10-20 ml/h) and increase carefully due to limited intestinal tolerance, as recommended by the American Society for Parenteral and Enteral Nutrition 4, 6, 7
It may take 5-7 days to reach target intake, according to the American Society for Parenteral and Enteral Nutrition 4, 6

Regular reassessment of nutritional status during hospital stay is necessary, as stated by the American Society for Parenteral and Enteral Nutrition 4
Continuation of nutritional support therapy including qualified dietary counseling after discharge is advised for patients who still do not adequately cover their energy requirements orally, according to the American Society for Parenteral and Enteral Nutrition 4

Despite low immediate morbidity with PEG placement, overall mortality within weeks of placement can be high due to poor patient selection, as noted by the European Society for Clinical Nutrition and Metabolism 2