Gastrostomy

• Long-term (> 4–6 weeks) gastric feeding required under the following circumstances:
  
  
  
  • Patient is unable to swallow.
    
  • Oral feeding is precluded.
    
  • Oral intake alone is inadequate.
  
  
• Long-term gastric decompression.
  
• Intolerance to nasogastric or Dobbhoff tube, or both.
  
  
  
  • In cases requiring access to the gastric lumen for < 4–6 weeks, a nasogastric or Dobbhoff tube generally suffices.
  
  
• Percutaneous endoscopic gastrostomy (PEG) is the procedure of choice, when feasible, for gastrostomy placement alone. If the stomach is not accessible percutaneously or if gastrostomy is performed at the time of another upper abdominal operation, an open technique is used.

Witzel Jejunostomy

• Secondary procedure during extensive upper digestive tract surgery (eg, esophagectomy, total gastrectomy) to enable early enteral feeding, particularly when recovery is expected to be long and potentially complicated.
  
• Sole procedure in patients in whom oral feeding is precluded and postpyloric feeding is desired (eg, patients with duodenal trauma, gastroparesis, or pancreatitis).

Gastrostomy

Absolute

• Absence of stomach (subtotal gastrectomy, transhiatal esophagectomy with gastric pullup).
  
• For PEG, esophageal obstruction. (Stamm gastrostomy remains feasible.)
  
• For PEG, lack of access to esophagus (eg, trismus, teeth wired shut). (Stamm gastrostomy remains feasible.)

Relative