Definitions
- G and GJ tube are feeding tubes that are inserted directly through the abdominal skin (percutaneous) to help deliver nutrition into your digestive system without having to go through the mouth and esophagus. Both tubes enter directly into the stomach, but the unique difference between the tubes is where they terminate.
- A gastrostomy tube (G-tube) is a feeding tube inserted directly through the abdomen into the stomach and terminates in the stomach.
- A gastrojejunostomy tube (GJ-tube) is a longer feeding tube, which is still inserted directly through the abdomen into the stomach, but terminates down in the intestines in a segment called the jejunum. Additionally, there is typically a port that sits in the stomach and serves to suction any feeding content or bile (natural intestinal digestive fluids) that move backwards into the stomach to prevent reflux, vomiting, and aspiration.
- Enteral feeding – any method of feeding that utilizes the digestive system, including G, GJ tubes.
- Parenteral feeding – Intravenous nutrition (through blood vessels)
Uses/indications
- In general, it is preferable to engage as much of the digestive system as safely and functionally possible. Practically, this means that the goal when providing nutrition is to deliver it directly into the stomach (G-tube) if possible, and if it is contra-indicated then to deliver further down the digestive system into the intestines.
- G-tube indications
- Broadly, the main indication for G-tube placement is inability to safely perform oral feeding in someone with a functional digestive system.
- These include many conditions, for example:
- Stroke
- Neuromuscular disease
- Dementia
- Oral or esophageal obstruction (malignancy, radiation)
- Post operative
- GJ-tube indications
- Broadly, a GJ tube is used in those who cannot tolerate oral feeding safely, but also cannot safely receive nutrition into their stomach.
- These include additional conditions, most commonly:
- Poor stomach motility, such as gastroparesis
- Severe reflux/vomiting or concern for aspiration
Contra-indications
- Stomach or intestinal obstruction – any obstruction beyond where the feeding tube goes would not allow for enteral feeding
- Uncorrectable coagulopathy (bleeding risk)
- Hemodynamic instability – typically patients will need to be in a relatively stable state clinically to do the procedure with less risk.
- Anatomic issues – can be inherent anatomy or prior procedures that make it difficult to place a percutaneous feeding tube.
Procedure
- Preparation
- Your physician will review your history/imaging.
- You will be made NPO (nothing by mouth) for 8 hours prior to the procedure
- NG (nasogastric) tube going from your nose to your stomach is typically placed overnight or before the procedure to insufflate (put air into) your stomach to help facilitate the procedure.
- Typically the procedure is done with light sedation, often using a benzodiazepine and pain medication to keep you comfortable.
- G and GJ tubes are most commonly placed either endoscopically, typically by gastroenterologists, or under radiographic guidance, by interventional radiologists. Another option is surgical placement, although not as common.
- The radiologic approach is done under fluoroscopy which is basically live, continuous x-rays. It typically is done in 30-60 minutes. The general procedure is as follows:
- Sterile preparation of the area overlying the stomach.
- Insufflating (adding air to) the stomach using the NG tube
- Images are taken of your abdomen to view the insufflated stomach and to make sure that there is nothing between your stomach and the anterior abdominal skin.
- The site of insertion is determined and marked.
- Lidocaine is used to numb the skin and underlying tissue followed by a small skin incision.
- Anchoring sutures are placed initially, by accessing the stomach to pull the stomach wall closer to the abdomen. 2-3 anchoring sutures are placed based on the operators choice.
- Preparation
- Next, A needle is pushed through the skin incision into the stomach, followed by a guide wire which helps keep the tract open while also designed to help guide the tube into place. All of this is done under continuous x-rays (fluoroscopy) that helps ensure the proper placement.
- The tube is inserted over the guide wire. The tubes have balloon or cuff at the end. The balloons are inflated with sterile water as per the recommendations to prevent it from being pulled out.
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- The tube is tested with injected material to confirm its function and in the proper location. It is then sutured in place.
What is a gastrostomy tube?
A hollow, flexible, and plastic tube that is inserted through the stomach to supply nutrition directly to the stomach and ensure the necessary caloric intake.
What is a percutaneous gastrojejunostomy?
A gastrojejunostomy is a minimally invasive procedure in which a long tube is inserted through the abdomen and into the small intestine in order to provide nutritional support to patients who cannot eat due to a blockage in their stomach.
Why do I need this procedure?
This procedure will aid individuals who are unable to eat normally due to neurological causes, physical conditions, and if a blockage is hindering food passing from stomach to the small intestine. The physician may recommend this procedure if the patient suffers from a chronic acid reflux.
How is this procedure performed?
A gastrostomy is performed by placing a tube through the abdominal wall into the stomach.
A gastrojejunostomy is performed by placing a tube through the abdominal wall into the stomach and then through the duodenum (first region of the small intestine) into the jejunum (middle part of the small intestine). The physician will utilize ultrasounds and x-ray imaging to guide the insertion/placement of the tube.
What occurs after this procedure?
These procedures are mostly performed as inpatients. The NG tube is removed after the procedure or the next day. The tube is connected to gravity drainage. Post procedure instructions are given to flush the catheter at regular intervals to keep it open. The patient will be monitored closely for any complications.
How long does this procedure take?
This procedure is usually completed within an hour. The times differ based on the complexity of the case.
When can the tube be used?
After 24 hrs, if the abdomen is soft, non-tender, the tube can be used for feeding. Care should be taken and clear understanding of the type of feeding and flushing should be known as it can clogging of the tubes.
What happens if its clogged?
The physician or nurse will check if the tube is blocked. Few techniques re used to unclog the tube. If this does not work, then it needs exchange.
What care should be taken of the tube?
The tube is secured with a balloon inside and the anchoring sutures are securing the access. The exit side should be kept clean. The anchoring sutures fall of in 10-14 days. If not fallen, advised to see the doctor to remove them. If left insitu, these can cause infection.
What long term maintenance is needed?
Some people need these tubes for long time. In these patients, there is a need for exchange of these tubes to avoid blockage or infection. The exchange is performed under x ray guidance and should be easy to perform.
What are the benefits of this procedure?
Generally less expensive and can be performed faster with minimal invasion.
Who performs this procedure?
The interventional radiologist will perform this procedure and determine the results as well.
What are the risks associated with this procedure?
Possible complications include peritonitis (inflammation of the thin tissue wall along the abdomen) or skin infection around the entry site of the tube.
