When dysphagia prevents safe or adequate oral intake, enteral tube feeding provides nutrition directly to the gastrointestinal tract, bypassing the swallowing mechanism. Three tube types are commonly used in Hong Kong: the nasogastric (NG) tube, the percutaneous endoscopic gastrostomy (PEG) tube, and the nasojejunal (NJ) tube. Each has specific indications, advantages, limitations, and care requirements. This guide helps patients, families, and carers understand the differences and what to expect.
An NG tube is a flexible plastic tube passed through the nostril, down the oesophagus, and into the stomach. It is the most commonly used feeding tube in acute hospital settings because it requires no surgical procedure and can be inserted at the bedside within minutes by a trained nurse.
NG tubes are the first-line choice for:
In Hong Kong’s Hospital Authority hospitals, NG tube insertion typically occurs within 24–48 hours of identifying that a patient’s oral intake is insufficient, particularly after stroke or other acute neurological events.
Insertion takes 5–10 minutes. The patient sits upright; the tube is lubricated and passed through the more patent nostril, following the floor of the nasal cavity. The patient is asked to swallow as the tube passes the throat. Position is confirmed by X-ray — this is mandatory in HA hospitals before any feeding commences, as misplacement into the lung can cause fatal aspiration of feed.
NG tubes are not intended for long-term use. The tube causes nasal irritation, increases pharyngeal secretions, and impairs the laryngeal elevation needed for safe swallowing. Long-term NG tubes may actually worsen dysphagia by reducing the practice stimulus for swallowing and by increasing reflux and aspiration risk. In HA practice, if oral feeding is unlikely to resume within 4–6 weeks, the clinical team will discuss conversion to a PEG tube.
Patients are sometimes discharged with an NG tube if short-term home tube feeding is required before a PEG can be placed, or while awaiting swallowing recovery. Home care responsibilities include:
The NG tube should be replaced every 4–6 weeks (depending on the tube material) by a nurse — never by the patient or family at home without specific training.
A PEG tube is a silicone or polyurethane feeding tube inserted directly through the abdominal wall into the stomach, placed under endoscopic guidance. It is the preferred route for long-term enteral nutrition when oral feeding is unlikely to resume within 4–6 weeks or permanently.
PEG tubes are indicated for:
In HK, the decision to proceed to PEG is made jointly between the gastroenterologist, SLT, dietitian, and the patient and family. Informed consent is required; the ethics of PEG placement in advanced dementia is a recognised area of clinical complexity — for these patients, the HA’s advance care planning framework and the Geriatrics team should be involved.
PEG insertion is an endoscopic day procedure performed under sedation, typically taking 20–30 minutes. A gastroscope is passed orally into the stomach; a light from the scope illuminates through the abdominal wall to mark the insertion site. A trocar is inserted through the abdominal wall under direct vision; the tube is pulled through and secured with an internal bumper and external fixator plate. The patient can begin feeding via the PEG within 4–24 hours.
A well-maintained PEG tube can remain functional for 2–5 years. It is invisible under clothing, allows full mobility, eliminates nasal irritation, and is associated with better long-term nutritional outcomes than NG tube feeding for patients with chronic dysphagia. In RCHEs, PEG feeding is operationally simpler and less prone to displacement than NG tube feeding.
Care responsibilities include:
An NJ tube is passed through the nostril (like an NG tube) but extends through the stomach and into the jejunum (the second part of the small intestine). It bypasses the stomach entirely.
NJ tubes are used in specialised circumstances where gastric feeding is contraindicated:
NJ tubes are less common than NG or PEG tubes in routine dysphagia management. Placement requires X-ray guidance or endoscopy and must be confirmed radiologically. They are less stable than PEG tubes and cannot be replaced at the bedside if displaced — the patient must return to hospital.
For all three tube types, the goal — where clinically achievable — is return to safe oral feeding. The transition process is managed by the SLT and dietitian and follows a structured approach:
In HA hospitals, the tube feeding transition protocol is coordinated by the dietitian using a standardised reduction schedule. Families should not reduce tube feed volumes independently — doing so without clinical oversight risks malnutrition during the transition period.
| Feature | NG Tube | PEG Tube | NJ Tube |
|---|---|---|---|
| Insertion site | Nose to stomach | Abdominal wall to stomach | Nose to jejunum |
| Insertion method | Bedside, no sedation | Endoscopy, sedation | X-ray or endoscopy guided |
| Intended duration | Under 4–6 weeks | Months to years | Weeks (short-term) |
| Replacement | Bedside, nurse | Hospital endoscopy | Hospital radiology |
| Main advantage | Rapid, no procedure | Long-term, stable | Bypasses stomach |
| Main limitation | Displacement, irritation, aspiration risk | Procedure required, stoma care | Complex placement, unstable |