TABLE 1.
Tube | Indication | Advantages | Disadvantages |
---|---|---|---|
Pigtail G tube eg, Dawson-Mueller Mac-loc pigtail (COOK Medical Inc, USA) |
Initial G tube used in the PRG technique | Available in a variety of sizes: 8.5–14 Fr Looped (pigtail) versus balloon distal end secures tube in stomach. Balloon devices can deflate, resulting in migration |
No external anchoring device – tube must be taped to skin to prevent migration Taping of tube can cause skin breakdown and/or allergic dermatitis Smaller bore tubes can easily become blocked Tube must be replaced under fluoroscopy |
GJ tube eg, COOK GJ tube (COOK Medical Inc, USA) |
Initial and replacement GJ tube used in the PRG technique | Gastric coil secures tube in stomach and looped (pigtail) distal end secures tube in jejunum Nonsurgical option for management of severe gastroesophageal reflux disease in children at high risk for aspiration |
No external anchoring device – tube must be taped to skin to prevent migration Distal end of tube can migrate from jejunum into stomach Taping tube to skin can cause skin breakdown and/or allergic dermatitis Smaller bore tubes can easily become blocked Tube must be replaced under fluoroscopy Looped distal end and tubes with a large bore size can increase the risk of intussusception Not available in a low-profile device |
PEG tube eg, MIC-PEG Feeding Tube (Kimberly-Clark Worldwide Inc, USA) |
Initial G tube used in the percutaneous endoscopic gastrostomy procedure | Bulb tip secures tube in stomach and external retention ring anchors tube Bulb tip does not deflate |
Not available under 14 Fr Device can be too big and heavy for small paediatric patients External retention ring moves and loosens over time, increasing risk of migration External retention ring can make cleaning of the stoma difficult, increase moisture around stoma and result in skin breakdown, infections, enlarged stomas and granulation tissue Taping tube to skin can cause skin breakdown and/or allergic dermatitis |
Balloon G tube eg, MIC G tube (Kimberly-Clark Worldwide Inc, USA) |
Replacement G tube device | Water-inflated balloon secures tube in stomach and external retention ring anchors tube Tube can be replaced by most trained health care providers and caregivers without the need for fluoroscopy or sedation |
Not available in sizes smaller than 12 Fr Device can be too big and heavy for small paediatric patients External anchoring device moves and loosens over time, increasing risk of migration External retention ring can make cleaning of the stoma difficult, increase moisture around stoma and result in skin breakdown, infections, enlarged stomas and granulation tissue Balloon device can deflate, resulting in migration and/or need for replacement Taping tube to skin can cause skin breakdown and/or allergic dermatitis |
Low-profile balloon G tube eg, MIC-KEY Low-Profile G tube (Kimberly-Clark Worldwide Inc, USA) |
Replacement G tube device A measuring device determines tube length |
Water-inflated balloon secures tube in stomach Low-profile device that does not migrate easily Does not require taping to skin for anchoring Proper stoma care is easy to provide Tube can be replaced by most trained health care providers and caregivers without the need for fluoroscopy or sedation Tubes start at 12 Fr and are less likely to become blocked |
Tube length must be appropriately sized for each patient to prevent migration and skin breakdown Balloon device can deflate or break, resulting in migration and/or the need for replacement Tube bore size starts at 12 Fr and may not be an option for small paediatric patients Tube and extension sets are costly |
Low-profile bulb G tube eg, BARD button (BARD Inc, USA) |
Replacement G tube device A measuring device determines tube length |
Internal bulb secures tube in stomach versus balloon Durable (1–2 years) Low-profile device that does not migrate easily Does not require taping to skin for anchoring Proper stoma care is easy to provide |
Tube must be inserted with an introducer, which is painful and increases the risk of perforation Patient may require sedation and/or fluoroscopy for the procedure, which must be performed by trained health care providers Leakage through external valve is common Tube bore size starts at 16 Fr and may not be an option for small paediatric patients Tube and extension sets are costly Tube should be replaced at 18–24 months to avoid tube breaking at the time of removal. If the internal bulb remains in the stomach, it can cause intestinal obstruction Tube is removed by direct traction, which can be painful and cause trauma to the stoma |
Low-profile balloon transgastric-jejunal tube eg, MIC-KEY Low Profile Transgastric-jejunal feeding tube (Kimberly-Clark Worldwide Inc, USA) |
Replacement GJ tube with gastric outlet for venting | Nonsurgical option for management of severe gastroesophageal reflux disease Low-profile device Large bore size reduces the risk of blockage |
Tube bore size starts at 16 Fr and may not be an option for small paediatric patients Bore size can increase the risk of intussusceptions Leakage through external valve is common Tube must be replaced under fluoroscopy Tube and extension sets are costly |
PRG Percutaneous retrograde gastrostomy