Patient Name: ,
DOB: SEX:
Ordering Physician: ,
PROCEDURE: Gastrostomy to gastrojejunostomy tube conversion with fluoroscopic guidance
DATE:
CLINICAL INDICATION:
OPERATING PHYSICIANS: John Doe, MD (Attending)/Jane Doe, MD (Fellow)
MEDICATIONS: Ancef 1 gram IV, Versed mg IV, fentanyl mcg IV
ACCESS: Existing percutaneous gastrostomy tube
CONTRAST:
FLUOROSCOPY TIME: minutes
COMPLICATIONS: None
IMPLANTABLE DEVICE: French gastrojejunostomy tube
PROCEDURE:
After written and informed consent was obtained, the patient was placed supine on the procedure table. The upper abdomen and existing tube were prepped and draped in standard sterile fashion. The patient received constant physiologic monitoring and conscious sedation from radiology nursing. A scout image was obtained. The skin and subcutaneous tissues around the gastrojejunostomy tube were anesthetized with 2% lidocaine. A guidewire was advanced through the gastrojejunostomy tube and coiled in the fundus. The gastrostomy tube was removed over the guidewire. A 65 cm 5 French Kumpe catheter was advanced over the guidewire towards the gastric fundus. The Amplatz guidewire was removed and contrast, saline, and gas was injected through the Kumpe catheter to distend and delineate the gastric and duodenal anatomy. Using the Kumpe catheter and a 0.035 inch stiff angled Glidewire, the wire and catheter were advanced through the pylorus, into the duodenum and proximal small bowel. The Kumpe catheter was removed and a 24 French peel-away sheath was placed over the guidewire into the duodenum. The inner dilator was removed and a new 22 French gastrojejunostomy tube was advanced through the sheath over the guidewire into position using fluoroscopy. Contrast was injected through the gastric and jejunal ports to confirm location. The retention balloon was inflated with 10 mL of normal saline. A sterile dressing was applied. The patient tolerated the procedure well without immediate complications and left the angiography suite in good condition.
FINDINGS: Scout image demonstrates a percutaneous gastrostomy tube projecting over the left upper quadrant. There is contrast in the colon. There is redundancy of the fundus and elevation of the left hemidiaphragm. The new gastrojejunostomy tube is in satisfactory position.
IMPRESSION: Successful conversion of a percutaneous gastrostomy tube to a percutaneous gastrojejunostomy tube.
Frequently Asked Questions
What is a gastrojejunostomy tube and why is it used?
A gastrojejunostomy tube (GJ tube) is a medical device inserted through the abdomen into the stomach and extends into the jejunum, the middle part of the small intestine. It is used for patients who cannot intake food orally, have difficulty with gastric emptying, or are at risk of aspiration. The GJ tube allows for direct feeding into the jejunum, bypassing the stomach, which can be beneficial for patients with certain digestive disorders.
How is a gastrostomy tube converted to a gastrojejunostomy tube?
The conversion involves a minimally invasive procedure using fluoroscopic guidance. First, the existing gastrostomy tube is removed, and a guidewire is inserted in its place. A catheter is used to navigate through the stomach into the small intestine. A new gastrojejunostomy tube is then inserted over the guidewire and secured in place. The procedure is monitored with imaging to ensure correct placement and is performed under sedation.
What preparations are needed for a gastrojejunostomy tube conversion?
Before the procedure, informed consent is obtained from the patient. The patient is positioned supine on the procedure table, and the area is prepared using sterile techniques. Continuous monitoring of vital signs is done throughout the procedure. Sedation and pain relief are typically administered to ensure patient comfort. The procedure requires coordination with radiology to use fluoroscopic imaging for accurate placement of the new tube.
Are there any risks or complications associated with gastrojejunostomy tube conversion?
While the procedure is generally safe, as with any medical intervention, there are potential risks. These can include infection, bleeding, or injury to surrounding organs. However, complications are rare, and the procedure is usually well-tolerated. The use of sterile techniques and real-time imaging helps minimize these risks. Post-procedure, patients are monitored for any signs of complications to ensure prompt management.
How is the success of a gastrojejunostomy tube placement confirmed?
The success of the GJ tube placement is confirmed using fluoroscopic imaging. Contrast material is injected through the gastric and jejunal ports of the tube, allowing visualization on the imaging screen. The correct position is verified when the contrast shows the tube's tip in the jejunum without any leaks or misplacement. This ensures that the tube is functioning as intended for effective nutrient delivery.