Name of the Procedure:

Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, any method, under fluoroscopic guidance (including contrast injection(s), if performed, image documentation).

Summary

In this procedure, obstructive material blocking various types of feeding or drainage tubes in the digestive system is mechanically removed. This is done using fluoroscopy, a type of real-time imaging technique, often with the aid of contrast dye to enhance visualization.

Purpose

This procedure addresses blockages in feeding or drainage tubes inserted in the stomach, duodenum, jejunum, or colon. It aims to restore proper function of these tubes, ensuring that they are free from obstructions so that nutrition or drainage can occur as intended.

Indications

• Blocked gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or colonic tubes.
• Symptoms such as nausea, vomiting, pain, or discomfort due to tube blockage.
• Inadequate nutrition or drainage because of a blocked tube.

Preparation

• Patients may be instructed to fast for a few hours prior to the procedure.
• Any necessary adjustments to current medications will be communicated by the healthcare provider.
• Diagnostic imaging or tests may be performed to assess the location and extent of the obstruction.

Procedure Description

1. The patient is positioned appropriately, and the area around the tube is cleaned and prepared.
2. A fluoroscope is used to provide real-time imaging of the tube.
3. Contrast dye may be injected into the tube to enhance visibility.
4. Specialized instruments are inserted through the tube to mechanically remove the obstructive material.
5. The tube is flushed to ensure it is clear.

6. Repeat imaging may be performed to confirm the obstruction has been removed.

   Tools: Fluoroscope, contrast dye, mechanical removal instruments (like guide wires, catheters).

Anesthesia: Local anesthesia or sedation might be used to minimize discomfort.

Duration

The procedure typically takes around 30 to 60 minutes.

Setting

Usually performed in a hospital's radiology or interventional radiology department.

Personnel

• Interventional Radiologist
• Radiology Technologist
• Nurses
• Anesthesiologist (if sedation is used)

Risks and Complications

• Infection at the tube site.
• Bleeding or injury to the surrounding tissues.
• Allergic reaction to the contrast dye.
• Incomplete removal of obstruction, requiring additional procedures.

Benefits

• Restoration of proper function of feeding or drainage tubes.
• Relief from symptoms associated with tube blockage.
• Improved nutritional intake and overall health.

Recovery

• Patients may be monitored for a short period post-procedure to ensure there are no immediate complications.
• Instructions for tube care and signs of potential complications will be given.
• Most patients can resume normal activities within a day or two.
• Follow-up appointments might be scheduled to ensure the tube remains clear.

Alternatives

• Attempting to flush the tube with a sterile solution before opting for mechanical removal.
• Replacement of the blocked tube with a new one.
• Surgical intervention in severe cases.

Pros and Cons:

• Flushing is less invasive but may not be as effective for severe blockages.
• Tube replacement is effective but requires tube removal and insertion.
• Surgical intervention is a last resort and carries higher risks.

Patient Experience

• Mild discomfort or pressure during the procedure, generally managed with local anesthesia or sedation.
• Following the procedure, some soreness at the tube site may occur, usually relieved by pain medication.
• Prompt relief of blockage-related symptoms and improved tube function.