The most common type of feeding tube is the gastrostomy (G) tube. G-tubes are placed through the abdominal wall into the stomach. This sounds scarier than it is. The G-tube surgery can be performed in three ways: surgically through small incisions using a laparoscope, surgically using a larger open incision, or endoscopically using a scope into the stomach to create the stoma from the inside. The endoscopic method has become the method of choice at many hospitals; however, some institutions still place tubes surgically, and children with anatomic abnormalities or who need other procedures may require a surgical placement. For more information on surgical placement, see our page on G-Tube Surgery.

There are a number of types of G-tubes. Any kind of G-tube can be placed initially. Often it is the surgeon or the gastroenterologist who determines the first type of G-tube placed.

PEG and Long Tubes

These are one-piece tubes held in place either by a retention balloon or by a bumper. They are often used as the initial G-tube for the first 8-12 weeks post-surgery. PEG specifically describes a long G-tube placed by endoscopy, and stands for percutaneous endoscopic gastrostomy. Sometimes the term PEG is used to describe all G-tubes. Surgeons may place other styles of long tubes.

Low Profile Tubes or Buttons

These tubes do not have a long tube permanently attached outside the stomach. Instead, they have a tube called an extension set that is attached for feeding or medication administration and then disconnected when not in use. When an extension set is not attached to the button, it lies fairly flat against the body. There are two types: balloon and non-balloon.

Balloon Buttons

Balloon buttons are held in place by a water-filled balloon. Balloon buttons are the most common G-tube for children once the stoma (G-tube site) is fully healed, usually in 2-3 months. The use of balloon buttons as a first G-tube is increasing among medical professionals. Balloon buttons can be replaced at home after caregiver training.

Non-Balloon Buttons

Some surgeons and gastroenterologists prefer the first G-tube to be a non-balloon button. Non-balloon buttons are harder to pull out than balloon buttons. Non-balloon buttons cannot be replaced at home. They are placed in the doctor’s office or at the hospital, sometimes with sedation or a topical pain reliever.

Gastric Tube Considerations

  • G-tubes can be more comfortable than nasal tubes and are a safer option for longer-term tube feeding.
  • There are low profile, button-style G-tubes that aren’t as noticeable under clothing.
  • The balloon button G-tubes can be replaced at home by a trained parent or caregiver.
  • Balloon buttons and tubes typically need to be replaced every 3 months, while non-balloon buttons need to changed less often, between every 6 months to a year.
  • G-tubes need to be placed surgically or endoscopically, and there is a recovery period after.
  • Little hands may also pull out G-tubes.
  • A common complication of G-tubes is the formation of granulation tissue (which looks like red, overgrown tissue around the tube site) during the healing process. It isn’t dangerous but it can be painful and irritating. It may also bleed easily. For more information, see the Granulation Tissue page.

Sizing for G-tubes

All G-tubes are sized by the width of the tube, which is measured using the French scale, across the diameter of the tube. G-tube buttons require a second measurement, in centimeters, based on the length of the tube’s stem (the part of the tube that is placed in the stoma or tube site). For example, a 16Fr 1.5cm tube has a French size (diameter) of 16 and a stem length of 1.5cm. The size is listed on MIC-KEY and AMT button G-tubes. G-tubes should have enough room between the tube and the skin to allow one or two coins to slide under. If the tube is pressing tightly against the skin or has much more room, your child may need a different stem size.

Living with a G-Tube

For information on venting, new stoma (site) care, securing the extension set, checking the balloon, or changing the tube, please continue on to our Living with a G-Tube page.