Enteral Nutrition via G-Tube and GJ-Tube

Anatomical Placement and Function

Food and nutritional formulas are administered through a G-tube into the stomach, while a GJ-tube has two ports - one for gastric decompression and another that delivers food directly into the jejunum, bypassing the stomach, as recommended by the American Gastroenterological Association 1
GJ-tubes have a dual-lumen design with a gastric port for decompression and medication administration, and a jejunal extension for direct small bowel feeding, according to the American Gastroenterological Association 1

G-tube feeding allows for bolus, intermittent, or continuous feeding methods due to the stomach's reservoir capacity, with a typical volume of 200-400 ml of feed administered over 15-60 minutes at regular intervals, as suggested by the European Society for Clinical Nutrition and Metabolism 2, 3
GJ-tube feeding requires continuous infusion rather than bolus feeding due to loss of the stomach reservoir, and bolus delivery into the jejunum must be avoided to prevent "dumping syndrome", as recommended by the American Gastroenterological Association 1, 2

G-tube indications include neurological disorders of swallowing, cognitive impairment, and mechanical obstruction to swallowing, as stated by the European Society for Clinical Nutrition and Metabolism 4
GJ-tube indications include patients at high risk for aspiration, gastroesophageal reflux that cannot be managed medically, and need for simultaneous gastric decompression and jejunal feeding, according to the American Gastroenterological Association 1, 2

G-tube complications include higher risk of aspiration, gastroesophageal reflux, and risk of aspiration pneumonia, particularly in patients with impaired consciousness, as reported by the European Society for Clinical Nutrition and Metabolism 5
GJ-tube complications include mechanical issues, jejunal extension displacement, diarrhea, and abdominal distension, which are more common with jejunal feeding, as noted by the American Gastroenterological Association 1

For G-tube feeding, patients should be positioned at 30° or more upright during and for 30 minutes after feeding to minimize aspiration risk, as recommended by the European Society for Clinical Nutrition and Metabolism 5
For GJ-tube feeding, continuous rather than bolus feeding is required through the jejunal port, as suggested by the American Gastroenterological Association 1
Flush tubes with water before and after every feed or medication to prevent blockage, as advised by the European Society for Clinical Nutrition and Metabolism 5