Tract disruption and external displacement following gastrostomy tube exchange in adults

Background: Anecdotal reports, mostly in children, indicate that disruption of the gastrostomy tract may occur during gastrostomy tube exchange and cause serious complications. The aim of our study was to determine the rate of tract disruption occurring in adults requiring long-term enteral nutrition who had an original gastrostomy tube replaced and to evaluate factors contributing to this complication. Methods: We retrospectively reviewed the medical records of all patients who underwent replacement of their gastrostomy tube over a 3-year period. Information was collected relating to patient demographics, underlying diagnosis, method of insertion and tube type used for initial gastrostomy tube and subsequent tube replacement, staff involved in tube replacement, patient nutritional status at the time of tube change, and the number of days from initial tube placement to replacement. For comparative purposes, the patients were divided into 2 groups: those with tract disruption and those without tract disruption. Results: A total of 182 tube changes in 108 adults were performed; 55 were initial tube changes. Four (7.3%) tract disruptions occurred, all with skin-level replacement devices and only with the initial replacement of the original gastrostomy tube. There were no significant differences in patient demographics, principal diagnosis, method of insertion and tube type used for initial gastrostomy tube, staff involved in tube replacement, patient nutritional status at the time of tube change, or the number of days from initial tube placement to replacement. Conclusion: Tract disruption occurs infrequently during replacement of gastrostomy tubes and appears to be an issue primarily during the initial tube exchange when using a skin-level device.