Special Procedures - Gastrostomy
Percutaneous feeding tubes (feeding tubes placed through the skin) are most often used in chronically ill children or adults or those who face a long-term issue of not being able to feed themselves.
Percutaneous feeding tubes may also be used in people who cannot swallow properly due to obstructions in their esophagus, malnutrition and/or gastric emptying problems. There are two main types of percutaneous feeding tubes: G-Tubes and GJ-Tubes, which are inserted by a radiologist using fluoroscopy or ultrasound. These two feeding tubes may be either temporary or permanent. Patients with percutaneous feeding tubes need careful monitoring for nutritional problems and signs of aspiration.
G-tubes (gastrostomy), which are inserted in the abdomen, provide a quick and simple entry to the stomach to provide nutrients when the patient needs help. A G-tube can provide a longer-term alternative to a nasogastric tube (NG-tube), which is placed through the nose and down the throat. Patients with G-tubes can be fed liquefied foods. This is performed under conscious sedation.
GJ-tubes (gastrojejunostomy) allow sidestepping the stomach for feeding. GJ-tubes are inserted through the stomach and pass through the stomach exit, across the duodenum and into the proximal small bowel. Only liquids can be used with a GJ-tube.
Initial placement of a G or GJ-tubes requires both injection of an anesthetic and conscious sedation. Replacement of a G or GJ-tube through an already-placed tract usually requires a topical or injectable anesthetic if needed.
Before inserting the G-tube, a nasogastric tube is inserted. During the procedure any fluid in the stomach will be withdrawn through the NG tube. Once the NG tube is in place, the radiologist determines the entry site for the new G-tube using fluoroscopic x-ray or ultrasound imaging. A local anesthetic is injected and a small incision is made. Usually, the G-tube site is located in the upper left abdomen below the rib.
After the stomach fluid is removed through the NG tube, the stomach is inflated with air with a hollow needle device. A contrast agent is injected through the needle to assure the needle is in the proper place in the stomach. Fluorscopic x-ray is used to view this. A guide-wire is then placed inside the needle and the needle is the removed leaving the guide-wire in place. The G-tube is placed over the guide-wire, and the guide-wire is then removed, leaving the G-tube in place. The G-tube is secured internally with a locking loop or inflatable balloon and externally to the skin with sutures or a plastic ring.
After the feeding tube is in place the patient is kept on bed rest for the rest of the day. Feedings start slowly the following morning. It is suggested that the tube not be changed for at least 2 weeks, so the tract can mature in place. The nasogastric tube (NG-tube) can be removed the following day.