Image guided percutaneous gastrostomy / gastrojejunostomy tube insertion

Radiologically inserted gastrostomy (RIG) and gastrojejunostomy (RIJ) tube insertion are minimally invasive procedures used to provide enteral access for nutritional support in patients who are unable to eat or swallow adequately. 

Radiologically Inserted Gastrostomy (RIG) Tube Insertion

1. Indications:
   • Inability to swallow or eat due to conditions such as stroke, neurological disorders, head and neck cancers, or severe dysphagia.
   • Need for long-term enteral feeding support to maintain adequate nutrition and hydration.
2. Pre-procedure Preparation:
   • Patient assessment, including medical history, nutritional status, coagulation profile, and suitability for enteral feeding.
   • Imaging studies (usually ultrasound or fluoroscopy) to assess the abdominal anatomy, locate the ideal insertion site, and plan the procedure.
3. Procedure Steps:
   • Local anesthesia is administered to numb the skin and underlying tissues at the selected insertion site on the abdomen (typically in the midline).
   • Using ultrasound or fluoroscopic guidance, a needle is inserted through the abdominal wall into the stomach, and contrast dye may be injected to confirm proper placement.
   • A guidewire is then advanced through the needle into the stomach, and the needle is withdrawn.
   • A dilator and sheath are passed over the guidewire, creating a tract for the gastrostomy tube insertion.
   • The gastrostomy tube, which is usually made of silicone or polyurethane, is then placed through the sheath into the stomach, and the sheath and dilator are removed.
   • The tube is secured to the skin with sutures or a stabilization device, and its position is confirmed with imaging (X-ray or fluoroscopy).
4. Post-procedure Care:
   • The gastrostomy tube is connected to an enteral feeding pump or gravity feeding system to initiate feeding gradually.
   • Regular monitoring of tube placement, skin integrity, feeding tolerance, and complications such as infection or leakage.
   • Patient and caregiver education on tube care, feeding administration, and recognizing signs of complications.
   • Follow-up appointments for tube maintenance, adjustments, and nutritional assessment.

Radiologically Inserted Gastrojejunostomy (RIJ) Tube Insertion

1. Indications:
   • In cases where gastric feeding is not feasible or tolerated, such as gastroparesis, gastric outlet obstruction, or risk of aspiration.
   • Need for direct feeding into the jejunum due to gastric dysfunction or bypassed stomach (e.g., post-gastric surgery).
2. Pre-procedure Preparation:
   • Similar to RIG, including patient assessment, imaging studies (usually fluoroscopy or CT), and nutritional evaluation.
   • Selection of the appropriate jejunal access route (e.g., percutaneous or endoscopic) based on the patient’s anatomy and clinical condition.
3. Procedure Steps
   • Local anesthesia is administered at the skin insertion site, typically in the upper abdomen or lower chest region.
   • Using fluoroscopic guidance, a needle is inserted into the stomach or small bowel to create a passage for the gastrojejunostomy tube.
   • A guidewire is advanced through the needle into the jejunum, and the needle is removed.
   • A dilator and sheath are passed over the guidewire, creating a tract for the gastrojejunostomy tube insertion.
   • The gastrojejunostomy tube, designed with a longer length to reach the jejunum, is inserted through the sheath and positioned in the jejunum.
   • The tube is secured to the skin, and its position is confirmed with imaging (X-ray or fluoroscopy).
4. Post-procedure Care:

• • Similar to RIG, including tube feeding initiation, monitoring for complications, patient education, and follow-up care.
  • Close monitoring of jejunal feeding tolerance, bowel function, and prevention of tube dislodgement or migration.
  • Nutritional support and adjustments based on the patient’s requirements and clinical progress.

Benefits

• • Minimally invasive with lower risks compared to surgical gastrostomy or jejunostomy.
  • Provides long-term enteral access for nutrition, hydration, and medication administration.
  • Improves patient comfort and quality of life by facilitating feeding in patients unable to eat orally.

Considerations 

• • Potential risks include infection, bleeding, tube dislodgement, peritonitis, or gastrointestinal complications.
  • Requires regular monitoring, tube care, and maintenance to prevent complications and ensure optimal enteral nutrition delivery.

Overall, radiologically inserted gastrostomy and gastrojejunostomy tube insertion are valuable procedures for providing enteral access and nutritional support in patients with swallowing difficulties or gastrointestinal dysfunction. Close collaboration between interventional radiologists, gastroenterologists, and nutritionists is essential for safe and effective tube placement, management, and patient care.