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

1. The patient is positioned on an X-ray table.
2. Local anesthesia is applied to the skin and the catheter site.
3. The existing gastrostomy tube is carefully removed.
4. 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).
5. Contrast dye is injected to ensure correct tube placement using fluoroscopic imaging.
6. The tube is securely positioned and checked for proper function.
7. 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.