Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report
CPT4 code
Name of the Procedure:
Insertion of Duodenostomy or Jejunostomy Tube, Percutaneous, Under Fluoroscopic Guidance
- Common Names: Duodenostomy tube insertion, Jejunostomy tube insertion
- Technical Terms: Percutaneous endoscopic gastrostomy (PEG) tube placement under fluoroscopy
Summary
This procedure involves placing a feeding tube directly into the duodenum or jejunum through the skin using X-ray guidance. The tube helps provide nutrition to patients who cannot eat by mouth.
Purpose
The procedure addresses severe gastrointestinal issues where oral feeding is not possible, such as blockages, severe swallowing disorders, or significant malnourishment. The goal is to ensure the patient receives necessary nutrients to maintain health and improve recovery chances.
Indications
- Severe dysphagia (trouble swallowing)
- Gastroparesis (delayed stomach emptying)
- Obstructions in the esophagus or stomach
- Certain cancers affecting the digestive tract
- Severe malnutrition where oral intake is insufficient
Preparation
- Patients may need to fast for several hours before the procedure.
- Necessary blood tests and imaging studies may be performed beforehand.
- Adjustments to medications, particularly blood thinners, as directed by the physician.
Procedure Description
- The patient is positioned on the procedure table and given anesthesia or sedation if needed.
- A small incision is made into the abdomen to access the duodenum or jejunum.
- Using fluoroscopic guidance, a tube is carefully inserted through the incision into the targeted area.
- Contrast dye is injected to confirm the correct placement of the tube using imaging.
- The tube is secured in place, and the incision is closed.
Tools used include:
- Fluoroscopy machine (X-ray)
- Contrast dye
- Feeding tube
Duration
The procedure typically takes about 30 to 60 minutes.
Setting
Performed in a hospital, often in the interventional radiology suite or operating room.
Personnel
- Interventional radiologist or surgeon
- Nurses
- Radiologic technologist
- Anesthesiologist (if sedation is used)
Risks and Complications
- Infection
- Bleeding
- Tube displacement or blockage
- Injury to adjacent organs (rare)
- Allergic reaction to contrast dye
Benefits
- Improved nutritional intake and health
- Enhanced recovery for patients unable to eat orally
- Stabilizes weight and nutrient levels
Recovery
- Initial observation in a medical setting for a few hours post-procedure.
- Instructions on how to care for the tube site.
- Regular follow-up appointments to check tube function and site health.
- Normal activities can usually be resumed within a few days, but heavy lifting should be avoided.
Alternatives
- Nasogastric tube (short-term)
- Total parenteral nutrition (IV nutrition, bypasses the gut)
- Surgical gastrostomy (more invasive)
Each alternative has its own benefits and drawbacks, such as the need for surgery or less comfort.
Patient Experience
During the procedure, the patient will likely be sedated and should feel minimal discomfort. Post-procedure, there may be some soreness at the incision site which can be managed with pain medications. The medical team will ensure the patient is comfortable and provide detailed instructions for at-home care.