Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices

Table 3 Select relative contraindications to gastrostomy placement

	Comments
Certain alterations in abdominal anatomy and motility[2,5]	Open abdomen, ostomy sites, drain tubes, and surgical scars can alter or preclude location for gastrostomy tube placement
Altered oropharyngeal anatomy[2]	Vocal cord paralysis, active radiation, head/neck tumors, facial and skull fractures, and high cervical fractures can obstruct the gastrostomy tube and create an airway emergency
Massive refractory ascites[2,162,163]	Increased risk for bacterial peritonitis, impairment of stoma tract maturation, and tube dislodgement if ascites rapidly reaccumulates over 7-10 d despite paracentesis or PleurX catheter placement; gastropexy devices can increase success
Upper GI bleeding from ulcer or varices[2]	Bleeding peptic ulcers and esophageal varices can have high rates of recurrent bleeding; bleeding from stress gastropathy, gastritis, or angiodysplasia are less likely to recur, and do not need a delay in enteral access
Obesity[2]	Shifting of panniculus increases the risk of tube dislodgement from the stomach into the peritoneal space
Early feeding in stroke with dysphagia[20,29,164-166]	Enteral tubes prior to 28 d rather than temporary NG tubes had greater development of pressure ulcers, sepsis, pneumonia, and GI bleeding over 2 yr
Nutrition in terminal metastatic malignancy[2,167,168]	Administration of nutrition beyond specific patient request plays a minimal role in comfort and does not improve complication rate, survival, or functionality in terminal malignancy
VP shunts[20,46,169,170]	May increase risk of ascending meningitis
Irreversible dementias[171-179]	Does not improve mortality or rehospitalization rate