Placement of percutaneous gastric tube of GJ tube

A GJ tube is a feeding tube. The tube goes from outside the abdomen, through the abdominal wall to the stomach, through the stomach (G for gastric which means stomach), and to the first part of the intestine called the jejunum (J). The feedings will bypass the stomach and go directly into the jejunum. There are different brands of GJ tubes, but they all have similar capabilities and function.

Conditions treated

Children that do not tolerate feedings directly into their stomach or unable to safely swallow or obtain adequate nutrition by mouth. This may be due to slow stomach emptying, severe reflux, severe stomach pain, or vomiting during feeds. Some children may need additional nutrition because of a medical condition or the need to gain weight.

Replacement procedure recovery

The child remains awake for this procedure. Replacement procedures are not typically uncomfortable and do not require sedation.

If your child has a GJ tube in place and only requires routine exchange for a new tube, your child will be placed on the fluoroscopy (x-ray) table. A guidewire will be placed through the indwelling tube and monitored under x-ray to ensure appropriate advancement of the wire. The indwelling tube is then removed. Over-the-wire a new tube is then advanced under x-ray. Contrast (x-ray) dye will then be infused through the jejuna (J) port to ensure appropriate positioning of the tube beyond the stomach. The retention balloon of the GJ tube will then be inflated with water to help ensure the GJ tube does not accidentally become dislodged.

If the GJ tube has fallen out or has been repositioned with the tube in the stomach, the indwelling tube will be removed. Under x-ray, a small catheter will be advanced through the ostomy (access site for tube in the skin surface) and advanced into the stomach, then into the small bowel to permit the advancement of the guidewire. Once the guidewire is advanced into the first portions of the small bowel (duodenum or jejunum) the catheter will be replaced for the GJ tube and proceed similar to a routine GJ tube exchange procedure described earlier.

Once the tube is in place on a routine change, feedings may resume immediately. For routine changes, there is rarely any pain afterward. If there is any mild discomfort, it may be controlled by ibuprofen or acetominphen. Following the procedure, your child may resume normal activities immediately.

Benefits of treatment

The benefit of having a GJ tube is that the child is able to receive nutrition and have the intestines function normally. GJ tube feeds decrease the risk of problems associated with having contents remain in the stomach, such as aspiration.

Risks of treatment

The risks could include some minimal, localized bleeding at the stoma site due to irritation. Should some bleeding occur this typically should stop within a few minutes upon completion of tube replacement. A rare complication in having a GJ tube is to get a have the tube pierce through the intestine (perforation). This is extremely rare. The tube is soft and flexible on placement and routine change will minimize the risk of the tube becoming stiff.