Name of the Procedure:

Replacement of Gastro-Jejunostomy Tube (GJ Tube), Percutaneous, Under Fluoroscopic Guidance with Contrast Injection(s) and Image Documentation

Summary

In this procedure, doctors replace an existing gastro-jejunostomy (GJ) tube through a small incision in the abdominal wall. They use fluoroscopy (a type of real-time X-ray) to guide the new tube into place and confirm its correct positioning using contrast dye.

Purpose

This procedure addresses the need for a functional GJ tube, which is essential for patients who cannot eat by mouth and require long-term feeding through their stomach and small intestine. The goal is to ensure safe and effective nutrition delivery directly into the small intestine, bypassing oral ingestion.

Indications

• Obstruction or malfunction of the current GJ tube
• Poor gastric emptying or severe gastroesophageal reflux
• Need for long-term enteral nutrition
• Conditions like gastroparesis or severe neurological impairment

Preparation

• Fasting for a prescribed period before the procedure
• Adjustments to current medications as instructed by the healthcare provider
• Pre-procedure blood tests and imaging studies as needed

Procedure Description

1. The patient is positioned and prepped, and a sterile field is maintained.
2. Local anesthesia is administered to numb the site.
3. Using fluoroscopic guidance, the existing GJ tube is removed.
4. A contrast dye is injected to visualize the placement area.
5. A new GJ tube is carefully inserted and guided into place using fluoroscopy.
6. The placement is confirmed with additional contrast injection and imaging.
7. The tube is secured, and the incision site is dressed.

Duration

The procedure typically takes between 30 minutes to 1 hour.

Setting

The procedure is performed in a hospital's interventional radiology suite or a specialized outpatient surgical center.

Personnel

• Interventional Radiologist
• Radiologic Technologist
• Nurse or Surgical Assistant
• Anesthesiologist (if sedation is used)

Risks and Complications

• Infection at the incision site
• Bleeding or injury to the surrounding organs
• Tube dislodgement or blockage
• Allergic reaction to contrast dye

Benefits

• Restores the functionality of the GJ tube for nutritional support
• Minimizes gastrointestinal symptoms associated with tube malfunction
• Immediate verification of correct tube placement

Recovery

• Observation for a few hours post-procedure
• Instructions to keep the site clean and dry
• Pain management with prescribed medications
• Follow-up appointments for tube check and replacement if needed

Alternatives

• Surgical replacement of the GJ tube
• Nasogastric or nasojejunal tube feeding, though less ideal for long-term use
• Intravenous nutrition (Total Parenteral Nutrition), which carries higher risks of complications

Patient Experience

• Mild discomfort or pressure during tube insertion
• Localized pain at the incision site, manageable with pain relief measures
• Fluoroscopy involves lying still and wearing protective gear against radiation
• Post-procedure soreness that typically resolves within a few days