Most patients who need nutrition support therapy receive it for less than a month. For short-term enteral feeding, nasogastric or orogastric tubes are usually the first choice. They are easy to insert and remove, come in different lengths and sizes, and can be placed at the bedside, under endoscopy, or with radiological guidance. However, when poor nutritional intake is expected to last more than four to six weeks, a gastrostomy is often the better option.
A gastrostomy is a feeding tube placed directly into the stomach through a small opening in the abdominal wall. It provides long-term enteral nutrition for people whose digestive system works normally but who cannot eat enough by mouth. Occasionally, it is also used to decompress the stomach or upper small bowel when there is an obstruction or volvulus.
The idea of a gastrostomy was first proposed in 1837 by Egeberg, a Norwegian army surgeon. But it was not until 1876 that Verneuil successfully placed one, using silver wire to bring the inner stomach wall and the abdominal wall together. Before that, the main obstacle had been postoperative peritonitis, which was often fatal. In 1894, Stamm improved Verneuil’s method, and later Dragstedt, Janeway, and Witze made further modifications in the 20th century.
A real breakthrough came in 1979. Two paediatricians in Cleveland, Ohio—Michael Gauderer and Jeffrey Ponsky—developed a way to insert a gastrostomy using an endoscope. They performed the first percutaneous endoscopic gastrostomy (PEG) on a six-month-old baby, using a 16 French mushroom-tipped catheter. They then successfully repeated the procedure on five more children. Ponsky later applied the technique to adults who had swallowing problems after a stroke, and interest in the method grew quickly. The “pull technique” they developed remains one of three endoscopic methods commonly used today. Compared with older surgical approaches, endoscopic insertion is far less invasive and is associated with lower rates of illness and death.
Just two years later, in 1981, Preshaw in Canada inserted the first gastrostomy using fluoroscopic guidance. Like the endoscopic method, the radiological technique has also been refined over time. Even so, endoscopic placement remains the most popular method of gastrostomy insertion worldwide. Radiological insertion is usually reserved for high-risk patients, people with throat or mouth cancer, or those for whom endoscopy is technically difficult.
Current status
Today, percutaneous endoscopic gastrostomy has become a routine procedure in many hospitals around the world. It is widely accepted as a safe and effective way to provide long-term enteral nutrition. However, as the UK national report from the early 2000s highlighted, there are still concerns about patient selection. In some cases, the procedure may be offered too late or to patients who are too unwell to benefit. Current clinical practice therefore places increasing emphasis on careful patient selection, multidisciplinary decision-making, and clearer communication with patients and families about the potential risks and benefits. While the techniques continue to improve, the key question is no longer just “how to do it” but “who should get it.”
Post time: Jun-02-2026