Balloon gastrostomy and button
A gastrostomy held in by a water-filled balloon, not a bumper - so it can be replaced through the tract at the bedside. The 3am point: confirm position before feeding, and keep the tract open.
Also called: balloon gastrostomy, balloon G-tube, MIC-KEY, mini button, gastrostomy button, low-profile gastrostomy, balloon-retained tube, replacement gastrostomy tube
What it is
A balloon gastrostomy is a feeding tube or low-profile button held in the stomach by a water-filled balloon instead of a solid bumper. Because the balloon can be deflated, these tubes are designed to be removed and replaced through the existing tract - often by the patient, carer or ward staff - which is exactly why they behave differently from a bumper PEG at 3am.
The ED-relevant facts follow from that: a balloon tube falls out more readily (balloon deflation or rupture), it can usually be replaced at the bedside through a mature tract, and the two things that go wrong are losing the tract and feeding before confirming the new tube is in the stomach. Used in adults and children (paediatric buttons are very common); paediatric replacement and feeding are directed by the child's team.
How to recognise it
- A tube or a flush, low-profile button on the abdomen with a balloon-inflation port marked with a volume in mL - the feature that distinguishes it from a bumper PEG.
- A patient or carer who says they 'change it themselves' - balloon tubes are routinely changed through the tract, unlike bumper PEGs.
- An extension set that clips onto a button for feeding; the button itself sits almost flush with the skin.
What it gets confused with
A standard PEG is held by a solid internal bumper and cannot be pulled out without endoscopy; a balloon tube is held by a water-filled balloon and comes out (and goes back) through the tract. Check for a balloon-inflation port. Treating a bumper PEG like a balloon tube - trying to pull it - is the error to avoid.
What goes wrong
Fallen out (balloon deflated or burst)
The button or tube has come out; the carer often has it. Balloon failure is the usual cause.
Red flag
The tract closes within hours. A balloon tube can usually be replaced through a mature tract by a competent person, the balloon re-inflated with the stated volume of water (not air), and - critically - position confirmed before any feed. If replacement is not possible, place a Foley to hold the tract and refer.
Balloon in the wrong place / position not confirmed
A tube that has just been replaced, where it is uncertain whether the balloon is in the stomach, in the tract, or beyond.
Red flag
Inflating a balloon in the tract or feeding into a false passage causes pain, obstruction or peritonitis. Confirm gastric position (aspirate pH and/or imaging per policy) before inflating fully or feeding.
Leakage, over-granulation or site infection
Leak of gastric content around the button, exuberant red tissue at the stoma (over-granulation), or a red, sore, discharging site.
Red flag
Check the balloon volume (an under-filled balloon leaks), treat infection and over-granulation, and refer persistent leakage to the nutrition team.
Blocked button or extension set
Feed or medication will not pass through the button or its extension.
Red flag
Flush gently with warm water; the extension set is a common culprit and can be changed. Do not force.
The first ten minutes
- If it is out, preserve the tract now - it closes within hours. Replace a balloon tube through a mature tract if your department's policy and your competence allow, inflating the balloon with the stated volume of water, or place a Foley catheter to hold the tract open, and refer.
- Confirm gastric position before inflating fully or feeding (aspirate pH and/or imaging per local policy). Do not feed into an unconfirmed tube.
- Match the tube size (French gauge and length/stoma length for a button) to the old device where possible; the carer usually knows it.
- For leakage, check the balloon is inflated to the correct volume, and treat site infection or over-granulation.
- Call the nutrition team (or paediatric team) for confirmation, sizing and ongoing feeding.
Do not
Who owns it
The nutrition support team (and paediatric team in children) own the device and the feeding plan. Tell them the device type and size, the balloon volume, whether position is confirmed, and the reason for attendance.
Who to call
The team and the criteria are national. The phone number is local, and this tool does not know it. Find it once, now, and write it on the department's own card — that is the part no website can do for you.
- Say the device name first
- Open with laryngectomy, LVAD, shunt — the single word changes who comes and what they bring. Do not bury it in the history.
- Say what you have already established
- Whether the device is patent, whether it has been removed or disturbed, and what you have already tried. The specialist is deciding whether to walk or run.
- Ask who owns it out of hours
- Device ownership and the on-call route often differ from the implanting specialty, and it is frequently a regional centre rather than your own hospital.
- The patient's own team is a resource, not an afterthought
- Named nurse specialists, home-care companies and device helplines answer questions nobody else can, and the patient usually has the number.
When the device is not the problem
A patient with a device gets pneumonia, sepsis, pulmonary oedema and myocardial infarction at the same rate as everybody else. The device is the most visible thing about them and it attracts the whole assessment.
- The NTSP says it out loud
- The project's own manual warns that
patients with tracheostomies can become unwell with all the problems that other patients get too. It is easy to become fixated with the tracheostomy.
The same sentence applies to every device in this tool. - Clear the device, then leave it
- Establish that the device is doing its job — the stoma is patent, the line draws back, the pump is running — and then assess the patient as you would anyone else.
- The anchoring runs both ways
- The opposite error is treating a device complication as a medical illness: a blocked gastrostomy read as vomiting, a baclofen pump failure read as sepsis.
- NTSP manual — Red flags · read in full
What the patient will be carrying
Carers of balloon-tube and button patients are usually trained to change the device and know its size and balloon volume, and often carry a spare. Ask - they are frequently more expert in the specific device than the ED.
Scope of this page
This page covers the balloon gastrostomy / button in the ED: replace through a mature tract if competent, inflate with water to the stated volume, confirm position before feeding, and preserve a closing tract. It does not cover first (de novo) gastrostomy insertion, which is a planned endoscopic or radiological procedure, nor the detailed feeding regimen. There is no single UK national guideline for balloon-tube replacement; practice follows the device instructions and local policy. Used in adults and children.