Name of the Procedure:

• Common Name: Low-Profile Gastrostomy Tube, Jejunostomy Tube
• Technical Terms: Percutaneous Endoscopic Gastrostomy (PEG), Low-profile Feeding Tube, B4088

Summary

A low-profile gastrostomy/jejunostomy tube is a device inserted directly into the stomach or small intestine through the abdominal wall to provide nutrition, hydration, or medication. The "low-profile" design refers to the tube being flush with the skin, making it less noticeable and more comfortable.

Purpose

• Medical Conditions Addressed: Gastroparesis, neurological disorders affecting swallowing (e.g., ALS, stroke), severe reflux, and certain cancers.
• Goals and Expected Outcomes: To facilitate long-term enteral feeding, ensuring patients receive adequate nutrition and hydration when oral intake is not possible.

Indications

• Symptoms/Conditions Warranting the Procedure: Difficulty swallowing (dysphagia), chronic malnutrition, inability to maintain adequate oral intake, recurrent aspiration pneumonia.
• Patient Criteria: Patients who need long-term nutrition support and have a functional gastrointestinal tract.

Preparation

• Pre-procedure Instructions: Patients may need to fast for 6-8 hours. Medication adjustments, particularly for blood thinners, may be necessary.
• Diagnostic Tests: Blood tests, imaging studies (like an abdominal ultrasound or x-ray), and a medical history review.

Procedure Description

1. Preparation:
   • Sterilizing the abdomen area.
   • Administering anesthesia or sedation.
2. Insertion:
   • A small incision is made through the skin and into the stomach/jejunum.
   • Using endoscopic guidance, the tube is positioned correctly.
   • The tube is then secured and checked for proper placement.
3. Tools/Equipment: Endoscope, specialized feeding tubes, sterile surgical instruments.
4. Anesthesia or Sedation: Local anesthesia with or without conscious sedation is typical, but general anesthesia may be used for complex cases.

Duration

• The procedure typically takes about 30-60 minutes.

Setting

• The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Healthcare Professionals Involved: Gastroenterologist or surgeon, nurses, anesthesiologist/anesthetist.

Risks and Complications

• Common Risks: Infection at the insertion site, tube displacement, leakage around the tube.
• Rare Risks: Peritonitis, internal bleeding, fistula formation.
• Complication Management: Antibiotics for infections, adjusting the tube, potential need for additional procedures.

Benefits

• Expected Benefits: Improved nutrition and hydration, enhanced quality of life, decreased risk of aspiration pneumonia.
• Timeframe for Benefits: Benefits are usually realized immediately after recovery from the procedure.

Recovery

• Post-procedure Care: Keeping the insertion site clean and dry; use of pain relievers if needed.
• Recovery Time: Most patients can return home the same day. Full recovery and adaptation to the feeding regimen typically take about 1-2 weeks.
• Follow-up: Regular check-ups to monitor tube function and site condition.

Alternatives

• Options: Nasogastric (NG) tube, intravenous (IV) nutrition (Total Parenteral Nutrition - TPN), continued oral feeding with assisted feeding techniques.
• Pros and Cons: NG tube is less invasive but less comfortable for long-term use. TPN avoids gastrointestinal use but comes with higher risks like infections and liver complications.

Patient Experience

• During the Procedure: Minimal discomfort due to sedation/anesthesia.
• After the Procedure: Mild to moderate pain at the insertion site, managed with analgesics. Most patients experience some initial discomfort but find the low-profile design more comfortable and less obtrusive than traditional tubes. Regular maintenance and care of the tube are required to prevent complications.