Conversion of gastrostomy tube to gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report
CPT4 code
Name of the Procedure:
Conversion of Gastrostomy Tube to Gastro-Jejunostomy Tube, Percutaneous, Under Fluoroscopic Guidance
Summary
This procedure involves changing an existing gastrostomy tube (which leads to the stomach) to a gastro-jejunostomy tube (which extends to the small intestine) through the skin, using X-ray imaging to guide the process.
Purpose
Medical Condition:
This procedure is often performed for patients who have difficulty emptying their stomachs or those at risk for aspiration.
Goals:
- To ensure better nutrition absorption by bypassing the stomach.
- To reduce the risk of aspiration pneumonia.
- To improve overall gastrointestinal functioning.
Indications
- Severe gastroesophageal reflux disease (GERD) not managed by medications
- Gastroparesis (delayed stomach emptying)
- Chronic aspiration risk
- Need for long-term enteral feeding when gastric feeding is not possible
Preparation
- Fasting for a specific period before the procedure, usually 6-8 hours.
- Adjustment or temporary discontinuation of certain medications (e.g., blood thinners).
- Blood tests to check coagulation status.
- Pre-procedure imaging to assess anatomy and tube placement.
Procedure Description
- The patient is positioned on an X-ray table.
- Local anesthesia is applied to the skin and the catheter site.
- The existing gastrostomy tube is carefully removed.
- Fluoroscopic guidance (continuous X-ray imaging) is used to navigate and guide the new gastro-jejunostomy tube into the jejunum (part of the small intestine).
- Contrast dye is injected to ensure correct tube placement using fluoroscopic imaging.
- The tube is securely positioned and checked for proper function.
- Image documentation is captured, and a detailed report is generated.
Tools and Equipment:
- Fluoroscope for imaging
- Gastro-jejunostomy tube
- Contrast dye
- Standard surgical instruments for tube insertion
Anesthesia:
Local anesthesia with possible mild sedation.
Duration
The procedure typically takes around 30 to 60 minutes.
Setting
The procedure is usually performed in a hospital's radiology department or an outpatient surgical center.
Personnel
- Interventional radiologist or gastroenterologist
- Radiologic technologist
- Surgical nurse
- Anesthesiologist or nurse anesthetist (if sedation is used)
Risks and Complications
- Infection at the insertion site
- Bleeding or injury to surrounding organs
- Dislodgement or blockage of the tube
- Peritonitis (rare)
- Allergic reaction to contrast dye (rare)
Benefits
- Improved digestion and nutrition absorption.
- Reduced risk of aspiration and associated complications.
- Immediate benefits can include easier feeding and fewer gastrointestinal symptoms.
Recovery
- Monitoring for a few hours post-procedure.
- Instructions on how to care for the new tube.
- Diet modifications and transition back to feeding.
- Follow-up appointments for tube maintenance and function checks.
Alternatives
- Continued use of a gastrostomy tube with adjusted feeding methods.
- Total Parenteral Nutrition (TPN), although it has its own risks and complications.
- Surgical procedures for direct intestinal feeding tube placement.
- Pros and cons: Alternatives may not provide the same improved digestion or reduced aspiration risks but may be considered based on patient health and preferences.
Patient Experience
- Mild discomfort or pain at the insertion site, manageable with over-the-counter pain medications.
- Possible sedation may result in grogginess for a few hours post-procedure.
- Instructions on tube maintenance and recognition of complications provided before discharge.
Pain management and comfort measures, such as local anesthesia and possible sedation, ensure patient comfort during the procedure.