What is a gastrostomy tube and why do I need one?

 A gastrostomy is a feeding tube that is inserted into your stomach. Prescribed liquid feed can be administered through the tube.

The side effects of radiotherapy to the head and neck include pain, difficulty swallowing, taste changes, dry mouth and thick secretions (saliva) that are hard to get rid of (please see other information sheet for more details). While we can support you to manage your side effects with medications, these problems can make it very difficult to eat enough, and you can become severely dehydrated or malnourished. Having a gastrostomy tube means that you will be able to keep yourself well-nourished and hydrated. This will help to keep you well enough to continue your treatment and reduce the risk of admission to hospital for treatment of dehydration or malnutrition.

Side effects build up through the course of treatment and can continue, and even get worse, for a period of time after treatment finishes. You may not need to start using the gastrostomy tube straight away, but will need to use it until you can eat and drink enough after treatment.

You will also see the Speech and Language Therapist during your treatment. They will give advice on the safest consistencies of food and drinks for you to have. They may also advise you to be nil by mouth.

The gastrostomy tube is usually placed prior to, or at the start of treatment. However, if you are not able to meet your nutrition or hydration needs earlier than this, the tube can be placed sooner so we can improve your nutrition and get you ready for your treatment.

           A balloon gastrostomy tube

What will happen at gastrostomy tube placement?

You will go to the Endoscopy unit on the day of your procedure. They will contact you with further details and provide guidance on preparing for the procedure.

You will be given a sedative into your vein to make you sleepy while the procedure is carried out.

An endoscope (a flexible tube with a camera at the end) is passed through your mouth, down the oesophagus (gullet) into your stomach. This is used to find a suitable position to place the tube.

Your stomach will be gently inflated with air, and a small cut made in your abdominal wall to allow the gastrostomy tube to be placed into your stomach. It will be held on the inside by either a small water-filled balloon or a flexible plastic bumper depending on the type of tube placed.

You will stay in hospital overnight after the procedure. This is for observation and to manage any pain you experience from the procedure.  Most people will be able to go home the following day, however if there are any issues, or you need to start using the gastrostomy for feeding straight away, you may need to remain in hospital for longer. After the procedure, you are likely to experience some discomfort in your stomach, this will improve as you heal from the tube placement. You are also likely to experience increased wind due to your stomach being inflated for the procedure. It is important that you tell your nurse on the ward if you are in pain.

How will I look after the gastrostomy tube at home?

A homecare nurse will visit you on the ward before you are discharged. They will demonstrate how to care for the tube, and how to feed through it. They will then visit you at home around 2 weeks after the placement to provide further training and support. They will give you supporting information leaflets and contact details in case you have any questions once you are home. We will also provide you with a tube care leaflet and guidance on what to do if you have any issues with your gastrostomy tube. This will be provided after the tube is placed.

Supplies of the equipment and feed you need will be delivered to your home by the homecare company. Your dietitian will organise this.

If you don’t need to start using the gastrostomy tube straight away, you will still need to flush it with water each day to make sure it doesn’t get blocked, and clean around the stoma site (the hole where the tube goes into your stomach) each day to reduce the risk of infections. Please see the separate tube care leaflet given.

It is important that you and anyone else supporting you are confident in looking after the gastrostomy. If you do not feel confident, it is vital that you tell your dietitian or homecare nurse as soon as possible so extra training can be arranged.

When will I need to start using the gastrostomy tube?

You will have regular contact with your dietitian throughout your treatment. This may be in person, via telephone or a both.

Your dietitian will monitor your weight and talk to you about what you are eating and drinking and any side effects you are experiencing. They will use this information to assess whether you are managing enough food or fluid.

They will help you to make modifications to your diet to improve your nutrition and keep your weight stable. It is important that you try not to lose weight during your treatment as this may result in breaks in treatment for your mask to be re-made.

If you are not able to manage enough to eat and drink, the dietitian will recommend starting to use your gastrostomy tube for feeding. This may be as a top-up alongside what you are able to manage by mouth, or you may be given a regime that gives your body everything it needs if you are unable to manage anything to eat and drink. We will work closely with the Speech and Language Therapist, who may also give you advice on the safety of your swallowing.

Your feeding plan is likely to change several times during and after your treatment depending on your needs. The dietitian will make changes to your feed deliveries as needed.

 How will I use the gastrostomy tube?

There are 2 different ways of feeding using the gastrostomy tube. Both methods can be used to give the same amount of nutrition and fluids, but you may find that one method of feeding is better for you. Your dietitian will help to guide you on what is going to fit in best with your needs. This can also change through treatment and you may like to use a combination of both methods.

• Bolus feeding: you will use a syringe to administer small amounts of feed at set intervals through the day. This allows you to have more of a “mealtime” pattern, which some people prefer. You will be advised on the amount of feed to put through the tube each time. This type of feeding is often preferred by people who are out of the house a lot, as it is easier to administer feed on the go
• Pump feeding: you will use an electronic pump to administer your feed for you slowly over a longer period of the day. This method of feeding is often preferred by people experiencing nausea, or struggling to tolerate a bigger volume of feed in their stomach at once. It is also useful if you are feeling tired. We will provide you with a backpack so you can be mobile while the feed is running.

When will the gastrostomy tube be taken out?

After you finish your treatment, the side effects will continue to increase for around 2 weeks before slowly starting to get better. If you are using the gastrostomy tube for feeding at the end of your treatment, it is likely that you will need to continue with this for a while before you are able to start moving back towards eating and drinking.

The length of time you will need to use your feeding tube varies. Things will improve gradually, so it is likely that you will need to continue to use the gastrostomy tube to top up what you are able to eat by mouth once you start eating and drinking. Your dietitian will support you to modify your diet to build up your nutrition by mouth and gradually reduce how much you need to use the tube.  If you stop using the gastrostomy tube too soon, you will start to lose weight and become malnourished. This will impact on your recovery from the treatment.

Once you are able to eat and drink enough by mouth to maintain your weight and nutrition, your dietitian will discuss with your managing consultant to get approval for the tube to be removed. Depending on the type of gastrostomy tube you have, this can either be done at home by the homecare nurse, or may need to be removed in the Endoscopy department.

If you need to continue to use the gastrostomy tube on a long-term basis, your dietitian will hand over your care to the Home Enteral Nutrition (HEN) team. This is a team of specialist dietitians who support people with feeding tubes at home.