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Standard G‐tubes are adjustable length tubes that have an external bolster, which sits on the skin and can be moved up and down to adequately secure the tube in a patient of any size (Figure 1.1 a and b). These are particularly helpful in patients with increased soft tissue or in patients with a projected weight gain where a low‐profile tube with a fixed shaft length may not fit properly. Standard G‐tubes can be placed surgically or endoscopically.

Standard G‐tubes are placed surgically using the Stamm procedure or via a laparoscopic approach. You will know your patient had the Stamm procedure if he or she has a 6–8 cm midline incision on examination. During the procedure, the surgeon dissects down to the anterior wall of the stomach. The G‐tube is placed directly into the stomach via an anterior incision. The balloon is inflated and used to pull the stomach against the inner abdominal wall to determine the best location for the percutaneous exit of the tubing. Once this incision is made, the tubing is pulled through the abdominal wall and the tube is anchored in place with sutures. A standard G‐tube placed surgically will have a well‐healed tract within four weeks.

Figure 1.1 Standard G‐tubes and low‐profile G‐tubes. (a) Standard GJ tube with three ports: balloon port, jejunal port, and gastric port. (b) Standard G‐tube with three ports: medication port, gastric port, and balloon port. (c) Low‐profile tubes with both nonballoon and balloon retention devices.

Standard G‐tubes are placed endoscopically by using the percutaneous endoscopic gastrostomy(PEG) technique. Of note, the term “PEG” is used inaccurately in medical vernacular to refer to all kinds of G‐tubes, but a PEG is actually the procedure and not a type of tube. During a PEG procedure, an endoscope is used to transilluminate the stomach and identify the stoma site. A needle is then inserted through the skin into the stomach with a guidewire that is pulled up through the esophagus and out of the mouth. This guidewire is then used to guide the G‐tube into the stomach. A small incision is made, and the G‐tube is pulled through the stomach and abdominal walls and secured in place by the internal and external bolsters alone.

There are two main advantages to a surgically placed G‐tube compared to a PEG procedure. First, a mature tract forms in 4 weeks with a laparoscopic procedure compared to 6–12 weeks with a PEG procedure. Second, a surgically placed G‐tube provides direct visualization of the anatomy, whereas, with an endoscopically placed G‐tube, there is always the risk of a bowel perforation if a portion of bowel is caught between the abdominal wall and the gastric wall during G‐tube placement.