PROCEDURE: Gastrojejunostomy tube check and repositioning with imaging guidance
DATE: 01/01/2022
CLINICAL INDICATION: Mr. 73 year old male with hx of PD dx 12 years ago with a GJ tube placement on research protocol receiving meds through the J tube which now appears to be clogged.
OPERATING PHYSICIANS: John Doe, MD (Attending)/Jane Doe, MD (Fellow)
MEDICATIONS: 2% lidocaine without epinephrine for local anesthesia
ACCESS: Existing gastrojejunostomy tube
CONTRAST: 15CC of nonionic contrast
FLUOROSCOPY TIME: 4.7 minutes
COMPLICATIONS: None
PROCEDURE: After written informed consent was obtained, the patient was placed supine on the procedure table. The abdomen and GJ tube were prepped and draped in standard sterile fashion. A scout image was obtained. Contrast was injected through both the gastrostomy and jejunostomy ports to confirm intraluminal location. A 0.035 inch stiff Glidewire was advanced through the jejunal port and the coiled portion of the jejunal tube looped in the duodenum was unfurled. The Glidewire was removed. Contrast was injected through the jejunal port to confirm location. The tube was then flushed.
FINDINGS: Scout image shows a gastrojejunostomy tube projecting over the abdomen. The new feeding tube follows a similar course and intraluminal positioning is confirmed with contrast injection.
IMPRESSION: Successful gastrojejunostomy tube evaluation and repositioning as above.
Frequently Asked Questions
What is a gastrojejunostomy tube used for?
A gastrojejunostomy (GJ) tube is used for feeding directly into the small intestine when oral intake is not possible or adequate. It bypasses the stomach, delivering nutrition and medications directly into the jejunum, which is part of the small intestine. This is particularly useful for patients who have had surgeries or conditions that impair gastric emptying or absorption.
How is a gastrojejunostomy tube repositioned?
Repositioning a GJ tube typically involves the use of imaging guidance, such as fluoroscopy, to ensure accurate placement. A guidewire may be inserted through the tube to help realign it within the digestive tract. Contrast dye is often used to confirm the tube's position, and adjustments are made as needed to ensure it is unobstructed and properly situated for feeding.
What are the common complications of a GJ tube?
Common complications of a GJ tube can include tube clogging, dislodgement, infection at the insertion site, and leakage of gastric contents. In the procedure described, there were no complications noted, indicating a successful intervention. Regular monitoring and maintenance are crucial to minimize risks associated with GJ tubes.
Why is imaging guidance used in GJ tube procedures?
Imaging guidance, like fluoroscopy, is used during GJ tube procedures to visualize the tube's position within the gastrointestinal tract. This ensures the tube is correctly placed and not obstructed, which is vital for effective feeding. Imaging allows for precise adjustments and helps avoid potential complications such as misplacement or injury to the intestines.
What is the role of lidocaine in a GJ tube procedure?
Lidocaine, a local anesthetic, is used to numb the area around the GJ tube insertion site during the procedure. This helps minimize discomfort for the patient. In this procedure, 2% lidocaine without epinephrine was used to provide local anesthesia, ensuring the patient remained comfortable while the tube was checked and repositioned.
What does it mean if a GJ tube is clogged?
A clogged GJ tube means that there is a blockage preventing the flow of nutrition or medication through the tube. This can occur due to thick feeding formulas, medication residues, or improper flushing. If a tube is clogged, it may need to be flushed or repositioned, as seen in the described procedure, to restore its function.
How is contrast used in checking a GJ tube?
Contrast material is injected through the GJ tube ports to visualize its position using imaging techniques like fluoroscopy. The contrast helps confirm that the tube is within the gastrointestinal tract and not displaced. This ensures the tube is correctly positioned to deliver nutrition and medications effectively, as shown in the procedure.