From
Live Event Content
Everything You Ever Wanted to Know About G-tubes But Were Afraid to Ask - Betsy Gerrein - APP Conference 2026
With Dr. Betsy Gerrein
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Clinical & Research Update: Renal Tumors with Drs. Ethan Smith, Lindsay Haacker, Michael Daugherty, and Meera Kotagal
71 min · Published Sep 2026
Video
Clinical & Research Update: Neuroblastoma with Drs. Katherine Somers, Cara Morin, Juan Gurria, and Meera Kotagal
67 min · Published Sep 2026
Video
Clinical & Research Update: Sarcoma w/ Drs. Roshni Dasgupta, Joseph Pressey, Arthur Meyer, Luke Pater
66 min · Published Sep 2026
Video
2026 Laparoscopic Pediatric Hernia Repair
123 min · Published Jun 2026
Video
Beyond the Spectrum: Diagnosis, Myths & Management - Caitlin Couch & Leslie Lopez - APP Conference 2026
50 min · Published May 2026
Video
Dysautonomia: Navigating the Journey - Martha Willis - APP Conference 2026
55 min · Published May 2026
What the experts said
Approximately 160,000 to 200,000 G-tube procedures are performed annually in the US, with about 15,000 of those in children.
Most G-tube care recommendations are expert opinion rather than evidence-based practice, with limited literature on routine care topics.
Button G-tubes are typically placed laparoscopically using a STEM gastrostomy procedure, where the surgeon sutures the stomach to the abdominal wall to ensure the tube goes directly into the stomach and prevents leaking into the peritoneum.
The AMT Mini One button is not provided by all home care companies; specifically, Lynncare does not carry this product.
Non-balloon AMT buttons are used for children who frequently pull their tubes out or have high abdominal pressure that causes tubes to pop out with coughing or sneezing.
Non-balloon buttons can last up to 6 months in some patients and require special training to insert and remove; parents do not change these tubes at home.
PEG tubes (percutaneous endoscopic gastrostomy) must stay in place for 12 weeks because the stomach is not sutured to the abdominal wall, and only a bolster holds it in place.
If a PEG tube is pulled out in the first 6 to 12 weeks, it is a medical emergency because the stomach can fall away from the abdomen and formula or medications can leak into the peritoneum.
GJ tubes must be placed under fluoroscopy, whether in the operating room or postoperatively, and are typically swapped out in fluoroscopy rather than interventional radiology.
AMT and Mickey tubes are no longer fully compatible despite AMT packaging stating 'Mickey feed set compatible'; using the wrong extension tube can cause it to break off inside the button.
The preferred dressing for G-tube sites is split gauze, not Meplex or cloth dressings that parents commonly purchase.
Leaking refers to stomach contents including acid coming out around the stoma, while drainage is usually more superficial and comes from granulation tissue, appearing yellow or slightly bloody.
Granulation tissue is normal healing tissue that appears pale pink and moist, can be smooth or cobblestone-looking, and secretes yellow or greenish exudate.
Silver nitrate application for granulation tissue can sting and burn, will stain skin and fingernails, and requires glove use and skin protection during application.
Granulotion should only be used for 14 days because it is severely drying; overuse causes friable-appearing skin.
Granulotion cannot be prescribed through pharmacies as it is an over-the-counter product available from granulotion.com or Amazon for approximately $48 per tube.
Gastric prolapse occurs with high intraabdominal pressure from conditions like peritoneal dialysis, organ transplant, or severe constipation, and causes severe leaking because the tube no longer fits tightly.
The only treatment for gastric prolapse is surgical resiting of the stoma, which should be used as a last resort because the underlying high pressure will likely cause the new stoma to prolapse again.
Keyholing (a tear in the stoma) is more likely to occur early after surgery and can cause mild to severe leakage that is difficult to heal.
Placing a larger French-size tube for keyholing just stretches the stoma more and does not help; some patients need admission for post-pyloric NG feeds to allow healing.
For yeast infections around G-tubes, treatment includes nystatin powder or cream, Cavilon no-sting spray to form an artificial scab, and then a moisture barrier on top.
True cellulitis around G-tube sites is rare and overdiagnosed, particularly within Cincinnati Children's Hospital.
G-tube sites should not be cultured because skin flora and normal GI bacteria are present, and cultures will not provide useful information.
Mupirocin is not recommended for G-tube site infections; if it helps, it is likely due to the Vaseline base protecting the skin rather than the antibiotic effect.
General surgery is responsible for the G-tube until the first change at approximately 6 weeks post-op, and general surgery must perform the first tube change.
Water should not be removed from the balloon prior to the first G-tube change at 6 weeks.
Criteria for G-tube removal include sustained weight gain over several months, 100% oral intake including medications, approval from the managing team, and avoiding removal during respiratory season.
After G-tube removal, the site will leak significantly for 2-3 days and can take 4-6 weeks to close; if still leaking after 4-6 weeks, referral back to general surgery for closure is needed.
If gastric prolapse is present, the G-tube site will not close spontaneously after tube removal because the gastric tissue prevents healing.
Granulation tissue typically appears in the first few weeks or months after tube placement, is usually paler and smoother or cobblestone-looking, and secretes yellow or greenish exudate.
Gastric prolapse is usually redder (sometimes bright red), bleeds easily, and when blood is seen on gauze, it indicates gastric tissue rather than granulation tissue.
Constipation is a treatable cause of increased abdominal pressure in G-tube patients; most children with gastrostomy tubes have some constipation due to liquid diet and lack of fiber.
For patients with tracheostomy and ventilation who are constantly coughing, gagging, and retching, the increased abdominal pressure causing prolapse may not be treatable.
The decision to resite a prolapsed G-tube is typically made after multiple clinic visits (3-4 times) when skin cannot be cleared or problems persist despite management attempts.