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World J Gastrointest Surg. Apr 27, 2022; 14(4): 286-303
Published online Apr 27, 2022. doi: 10.4240/wjgs.v14.i4.286
Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices
Anand Rajan, Peerapol Wangrattanapranee, Jonathan Kessler, Trilokesh Dey Kidambi, James H Tabibian
Anand Rajan, Department ofGastroenterology, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
Anand Rajan, Trilokesh Dey Kidambi, Department ofGastroenterology, City of Hope Medical Center, Duarte, CA 91010, United States
Peerapol Wangrattanapranee, Department ofMedicine, Keck School of Medicine of USC, Los Angeles, CA 90033, United States
Jonathan Kessler, Department ofInterventional Radiology, City of Hope Medical Center, Duarte, CA 91010, United States
James H Tabibian, Department ofGastroenterology, UCLA-Olive View Medical Center, Sylmar, CA 91342, United States
Author contributions: Rajan AV drafted the manuscript; Wangrattanapranee P designed the illustrations and provided revisions; Kessler J provided revisions; Kidambi T provided revisions; Tabibian J provided revisions and supervision; and All authors have read and approve the final manuscript.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: James H Tabibian, FACP, MD, PhD, Associate Professor, Department of Gastroenterology, UCLA-Olive View Medical Center, 14445 Olive View Drive, Sylmar, CA 91342, United States. jtabibian@dhs.lacounty.gov
Received: December 18, 2021
Peer-review started: December 18, 2021
First decision: January 27, 2022
Revised: February 9, 2022
Accepted: April 3, 2022
Article in press: April 3, 2022
Published online: April 27, 2022
Processing time: 126 Days and 15.7 Hours
Abstract

Gastrostomy tube placement is a procedure that achieves enteral access for nutrition, decompression, and medication administration. Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events (AEs). Appropriate indications, contraindications, ethical considerations, and comorbidities of patients referred for gastrostomy placement should be weighed and balanced. Additionally, endoscopist should consider either a transoral or transabdominal approach is appropriate, and radiologic or surgical gastrostomy tube placement is needed. However, medical history, physical examination, and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.

Keywords: Gastrostomy; Gastropexy; Enterostomy; Decompression; Enteral nutrition; Endoscopy

Core Tip: We reviewed 179 articles and compiled suggested considerations, especially for endoscopists, in the preprocedural evaluation of gastrostomy candidates. Patients referred to for gastrostomy tube placement should be evaluated for indications, contraindications, ethical considerations, and comorbidities. Additionally, the proceduralist should consider whether radiologic or surgical tube placement may be more appropriate, and whether a transoral or transabdominal approach is appropriate. Prior to the procedure, physical examination, imaging, and other interventions should be performed to reduce adverse events.