Interventional Radiology: Abdominal
Feeding Tubes

Also called: gastrostomy (G-tube) and gastrojejunostomy (GJ-tube)

Percutaneous feeding tubes (feeding tubes placed through the skin) are most often indicated in chronically ill children or adults or those, who face long term (greater than 4 to 6 weeks) inability to feed themselves.

Percutaneous feeding tubes may be indicated in those with an impaired ability to swallow, obstruction of the esophagus, malnutrition and/or gastric emptying problems. There are two basic types of percutaneous feeding tubes (G-Tubes and GJ-Tubes) inserted under imaging by a radiologist. These feeding tubes may be temporary or permanent. Patients with percutaneous feeding tubes need careful monitoring for nutritional problems and signs of aspiration.

G-tubes (gastrostomy), which are inserted in the abdomen, provide quick and simple access to the stomach for purposes of nutritional support when oral intake is inadequate. A G-tube can provide a long term alternative to a nasogastric tube (NG-tube), which is placed through the nose and down the throat. Patients with G-tubes can be fed blenderized foods.

GJ-tubes (gastrojejunostomy) permit bypass of the stomach for feeding. GJ-tubes are inserted through the stomach and pass through the pylorus (stomach exit), across the duodenum and into the proximal small bowel (the jgunum). Only liquids may be inserted through a GJ-tube.

Initial placement of a G or GJ-tubes requires both injection of a local anesthetic usually, Lidocaine and conscious / IV sedation. Replacement of a G or GJ-tube through a well established tract typically requires a topical anesthetic and/or injectable Lidocaine (as needed).

Prior to insertion of the G-tube, a nasogastric tube is inserted (if not already in place). During the procedure any fluid in the stomach will be withdrawn through the NG tube. Once the NG tube is in place, the radiologist determines the entry site for the new G-tube using fluoroscopic x-ray or ultrasound imaging. A local anesthetic is injected and a small 1/4 inch incision is made. Generally, the G-tube site is in the upper left abdomen below the rib margin.

After stomach fluid is removed via the NG tube, the stomach is inflated with air for easy entry into the stomach through a small incision with a hollow needle device. A contrast agent is injected through the needle to confirm proper placement of the needle in the stomach under fluoroscopic x-ray. A guidewire is then placed inside the needle, and the needle is the removed leaving the guidewire in place. The G-tube is placed over the guidewire, and the guidewire is removed leaving the G-tube in place. The G-tube is secured internally with a locking loop or inflatable balloon and externally to the skin with sutures or a plastic ring.

Following placement of a feeding tube, patients are kept at bed rest for the balance of the day. Feedings are begun gradually the following morning. It is generally advised that the tube not be changed for at least 2 weeks, while a tract matures. The nasogastric tube (NG-tube) can be removed the following day.