Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report
CPT4 code
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
- The patient is positioned and prepped, and a sterile field is maintained.
- Local anesthesia is administered to numb the site.
- Using fluoroscopic guidance, the existing GJ tube is removed.
- A contrast dye is injected to visualize the placement area.
- A new GJ tube is carefully inserted and guided into place using fluoroscopy.
- The placement is confirmed with additional contrast injection and imaging.
- 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