Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report
CPT4 code
Name of the Procedure:
Insertion of Gastrostomy Tube, Percutaneous, Under Fluoroscopic Guidance (also known as Percutaneous Endoscopic Gastrostomy - PEG)
Summary
A gastrostomy tube is inserted through the skin directly into the stomach to provide a means of feeding when oral intake is not possible. The procedure is minimally invasive and performed with the guidance of fluoroscopic imaging and contrast injections to ensure accurate placement.
Purpose
This procedure addresses the inability to take adequate nutrition orally due to conditions like neurological disorders, head and neck cancers, or severe swallowing difficulties. The goal is to provide long-term nutritional support and maintain gastrointestinal function.
Indications
- Severe swallowing disorders
- Neurological impairments (e.g., stroke, ALS)
- Head and neck cancer
- Severe burns or trauma to the mouth or esophagus
- Critical illness requiring prolonged nutritional support
Preparation
- Fasting for at least 6-8 hours prior to the procedure
- Adjustments to medication as instructed by a healthcare provider
- Pre-procedure blood tests to check for any clotting disorders
- Other imaging studies as needed to assess anatomy
Procedure Description
- The patient is positioned and given a sedative or local anesthesia.
- A small incision is made in the skin of the abdomen.
- A needle is inserted through the incision and into the stomach, using fluoroscopic imaging for guidance.
- Contrast dye is injected to visualize the stomach and ensure correct placement.
- A guide wire is placed through the needle into the stomach.
- Over the guide wire, the gastrostomy tube is inserted and secured.
- The positioning is confirmed again via fluoroscopy, and the incision site is dressed.
Duration
The procedure typically takes 30 to 60 minutes.
Setting
Performed in a hospital setting, often in a specialized radiology or endoscopy suite.
Personnel
- Interventional radiologist or gastroenterologist
- Nurses and radiologic technologists
- Anesthesiologist or nurse anesthetist (for sedation)
Risks and Complications
- Infection at the insertion site
- Bleeding or hemorrhage
- Injury to surrounding organs
- Displacement or clogging of the tube
- Peritonitis (inflammation of the abdominal lining)
Benefits
- Reliable method of long-term nutritional support
- Potential improvement in overall health and quality of life
- Reduced risk of aspiration pneumonia compared to oral feeding
Recovery
- Monitoring in a recovery area for a few hours post-procedure
- Instructions on how to care for the gastrostomy tube and the insertion site
- Pain management with prescribed medications
- Follow-up appointments to check tube function and condition
- Gradual introduction of feedings through the tube under the supervision of a dietitian
Alternatives
- Nasogastric (NG) tube feeding: temporary solution, less comfortable for long-term use
- Intravenous (IV) nutrition: used when the gastrointestinal tract cannot be used for feeding
- Surgical gastrostomy: involves larger incision, longer recovery time
Patient Experience
Patients may feel slight discomfort or pressure during the procedure due to the sedative or local anesthesia. Post-procedure, there may be soreness or tenderness at the insertion site, manageable with pain relief medications. Most patients adapt quickly to the presence of the gastrostomy tube and find it significantly improves their nutritional intake.