Gastrojejunostomy tube insertion/change - A guide for patients

Introduction

Tube insertion or change to allow safe feeding of people with impaired swallowing.

What is a Gastrojejunostomy tube insertion/change?

• A Gastrojejunostomy (GJ) feeding tube insertion is a procedure where a feeding tube is inserted into the first part of the bowel through an existing gastrostomy (a hole between the skin and stomach, which has been formed surgically).
• These feeding tubes will be subsequently changed usually every 3-4 months.
• Tube changes are usually much quicker than the initial insertion as the tip of the tube is usually in the correct position and the tube can simply be replaced over a wire.
• The feeding tube has three ports; one for the balloon, one for the stomach and one for the jejunum (small intestines). One of the specialist nurses will educate you in using the tubes, the different ports and maintaining and checking the tube.
• Normally bowel does not show up on an ordinary x-ray so a dye, called contrast medium, is injected into the bowel through a fine plastic tube called a catheter to make it visible.
• X-rays are taken during the procedure. These images will assist the doctors in performing the procedure.

Why do I need this procedure?

• A GJ feeding tube is usually suggested after gastrostomy feeding has been unsuccessful.
• Some people cannot tolerate feeding directly into the stomach, so a GJ tube can be helpful as it bypasses the stomach.
• A GJ tube can be helpful for people with gastric motility problems, where food does not pass through the stomach to the intestines as it should.
• Children or young people with gastro-oesophageal reflux may benefit from GJ feeding as the feed is delivered directly to the jejunum rather than the stomach. This stops stomach contents travelling back (reflux) up the oesophagus (food pipe), causing pain and potentially chest infection if the liquid is inhaled into the lungs (aspiration).

Who has made the decision for me to have this procedure?

The consultant in charge of your case and the radiologist performing the Gastrojejunostomy insertion/change will have discussed your case and come to the conclusion that this is the best way of treating your condition.

You will have the opportunity for your opinion to be taken into account, and if after discussion with your doctors, you do not want the procedure carried out, you can decide against it.

Who will be performing the procedure and other staff you are likely to meet?

• A specially trained doctor called an Interventional Radiologist will be performing your procedure.
• Radiologists have special expertise in using x-ray equipment and in interpreting the images produced, as well as performing minimally invasive procedures.
• They will look at these images whilst carrying out the procedure.
• The Interventional Radiologist will be assisted by a radiographer and nurses and/or other Radiology doctors or trainees.

Where will the procedure take place?

You will be taken to the Interventional Radiology Department.

What happens before my procedure?

• Children or young people requiring sedation will be admitted to hospital on the day of the procedure.
• If sedation is not required, this procedure can be performed as an outpatient.
• For most children and young people feed can be administered right up to the time of the feeding tube change. If feed needs to be stopped in advance you will be informed of this.
• A doctor will take a medical history from you.
• If you have any allergies you must let your doctor know and a red allergy band will be attached to your wrist.
• If you have previously reacted to intravenous contrast medium (the dye used for CT scans), you must also tell your doctor about this.

What happens during the procedure?

• You will lie on the x-ray table, generally flat on your back.
• You may have a monitoring device attached to your finger.
• The procedure is performed under sterile conditions and the radiologist and scrub nurse will wear sterile theatre gowns and operating gloves.
• For insertion, a catheter (plastic tube) is inserted into the existing gastrostomy. Under x-ray guidance a wire is manipulated and is positioned in the first part of the bowel. The GJ feeding tube is then placed in the correct position over the wire. The GJ feeding tube is secured in place.
• The feeding tube will be subsequently changed every 3-4 months.
• Tube changes are usually much quicker than the initial insertion as the tip of the tube is usually in the correct position and the tube can simply be replaced over a wire.
• Once the procedure is completed you will be moved back onto your hospital bed or can go home.

Will the procedure hurt?

• Most children/young people have minimal or no pain during the procedure.
• It is common that children to do not like the sensation of the old tube coming out and the new tube being placed but this usually does not represent pain.
• If a child or young person is agitated during the procedure sedation can be considered for future changes.
• There will be a nurse, or another member of the clinical staff, in the room looking after you.
• If the procedure does become uncomfortable, please let a member of staff know.

How long does the procedure take?

Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Initial GJ tube insertion usually takes 15-30 minutes. GJ tube changes are much quicker, usually taking 5 minutes.

What will happen after the procedure?

• For patients that have had sedation, you will be taken back to your ward for observations and a period of bed rest, prior to being sent home.
• If no sedation is given you can usually go straight home.

What are the benefits and possible risks of the procedure?

Benefits

• The GJ feeding tube will allow liquid food to be given directly into the gastrojejunostomy and bypasses the stomach in order to provide nutrition.

Risks

• A GJ feeding tube insertion/change is a safe procedure, but as with any medical procedure there are some risks and complications that can arise.
• A small chance of infection.
• A small chance of bleeding
• Malpositioning of the tube resulting in tube being positioned in the stomach.

Radiation

• You have been referred for an Interventional Radiology procedure to help deliver your treatment. A specialist in radiology agrees that this is the best procedure to treat your clinical condition and that the benefit of the examination is greater than the risk.
• The x-ray involves a dose of ionising radiation equivalent to a few months or years of natural background radiation which we are all exposed to every day.
• Ionising radiation can cause cell damage that may turn cancerous, however the risk of this happening from your examination is considered low.
• Depending on the length of the procedure there may also be a small risk of an excess radiation dose to the skin leading to short term and long-term effects (e.g. reddening of the skin and burns).
• If this happens as a result of this procedure, you will receive further advice following the procedure. The dose delivered will be kept as low as is practicable.
• For further information please see the information on our webpage.

Accessibility requirements

If you require support for your appointment, e.g. if you find it hard to hear, see or be understood by others, please let the receptionist or healthcare professional know on arrival or contact us:

• Email

or

• Telephone: 01223 256998

Pregnancy status

We have a legal responsibility to enquire if you are pregnant. Any patient aged between 12-55 years will be asked if there is a possibility they could be pregnant. This is important for us to know before you have your examination involving ionising radiation.

You can discuss this with a healthcare professional in private if you wish.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP.

Can I bring someone with me?

Those accompanying you may be required to stay out of the examination room during the procedure and remain in the waiting area.

Childcare whilst in the department

Staff are unable to look after or supervise children whilst your procedure is taking place. Please make alternative arrangements for the care of your children whilst you attend for your procedure. If you attend an appointment with children with no one to look after them whilst you have your procedure, then your appointment will unfortunately have to be cancelled and rescheduled.

Personal belongings

Patients are advised to bring minimal belongings and not to bring valuable items. Any valuable belongings (mobile phone, wallet etc.) will go with the patient while having their procedure and can be secured in a locked box/safe.

How, when and by whom will my results be communicated?

Imaging examinations are reported in order of clinical priority to ensure those with the highest urgency are reported first.

Your referring team or clinician will be responsible for communicating reports back to you.

Test results are made available via MyChart but there is 3-week delay from when an examination has been reported to when it is available on MyChart, in order to allow time for your clinical team to be able to see and action the results prior to them being released to the individual patient.

Contacts/Further information

Please call the Radiology Day Unit and speak to the Imaging Nurses, on telephone number 01223 254639 if you have any questions or concerns about this procedure.

Some of your questions about the procedure should have been answered by this leaflet, but remember this is only a starting point for discussion about your treatment with the doctors looking after you and you will be able to discuss any questions you have with them.

Require leaflet in a different format or language?

The Recite Me toolbar makes our website digitally inclusive by allowing you to customise the contents so that it works best for you. It features an accessibility tools bar positioned at the top of webpage:

Key functions:

• Screen reader – option for all information on the website to be read aloud.
• Translation – option to translate all information into over 100 different languages.
• Styling and customisation – option to change the text, font style, size, colour and spacing so that the information is easier to read.
• Reading aids – including a screen mask (tint) and magnifier to help make the information more accessible for all.

Question, concern or complaint?

Firstly speak to your nurse, doctor or other staff member as soon as you can so they can do their best to put things right straightaway.

If you don’t feel able to speak directly to the people caring for you, contact the patient advice and liaison service (PALS).

• Please call 01223 216756 9am to 4pm Monday to Friday,
• Via email
• Via a form available via link on the CUH PALS webpage.

PALS is open every weekday, and you can leave a message in the evenings and weekends.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.

• More information is available on our website: Mychart

This document has been adapted from one prepared by the British Society of Interventional Radiology (BSIR).