Enteric Access
Several diseases can make it difficult for a patient to eat and drink. In the short-term, doctors can treat this difficulty by placing a tube down the patient’s nose or mouth to their stomach/small bowel. Nutrition can then be administered through this tube. Unfortunately, if these tubes remain in place for too much time, they can stop working or even hurt the patient’s mouth/nose. In these cases, Interventional Radiologists at HRA can help patients and physicians by placing tubes directly through the belly wall into the stomach and/or small bowel. These tubes can remain in place until the patient is able to eat and drink adequately with a much lower risk of complications.
Placement
All of these tubes are placed in generally the same way. A small catheter is advanced via the patient’s nose/mouth into their stomach. This tube is used to inflate the stomach like a balloon. Under x-ray and ultrasound guidance, several small needles are advanced across the belly wall into the stomach and/or small bowel. These needles are used to place small, temporary tacks into the target so that it doesn’t move. Once the target is locked in place, another needle is advanced across the belly wall into the target. A wire is advanced into the target structure via the needle. The needle is exchanged over the wire for a catheter, and the wire is then removed.
The procedure has a mild to moderate risk of bleeding, infection, and damage to nearby organs. All patients should refrain from eating and drinking for 6 hours prior to the procedure and will be given medications to help them relax (i.e. moderate sedation). Finally, all patients remain in the hospital overnight after their procedure.
Replacement
If a tube becomes dislodged, it is important to come to interventional radiology or the hospital within 24 hours to have something placed within the hole. If the patient waits too long, the hole can heal up and a new tube will have to be placed from a different access. If the hole remains open or the tube is clogged (but still in place), all of the tubes can be replaced in generally the same way. The hole where the tube is usually located (or the indwelling, malfunctioning tube) is probed with a small catheter and wire. The wire and catheter are advanced to the target location. The small catheter is then exchanged over the wire for a new enteric tube, and the wire is removed.
Replacement has a low risk of bleeding, infection, and damage to nearby organs. All patients should refrain from eating and drinking for 6 hours prior to the procedure. If desired, patients can receive medications to help them relax during the procedure. Replacement can be performed on both inpatients and outpatients with malfunctioning catheters. After the procedure, inpatients can return to their room, and outpatients may return home.
Removal
If the tube was recently placed, it needs to remain in place for a minimum of 6 weeks to ensure that the hole in the belly wall and stomach/small bowel has had a chance to mature. After that time, however, if a patient recovers and is able to eat and drink adequately for several weeks consecutively, the tube can be removed. All tubes are removed in generally the same way. The retention balloon is deflated, and the tube is removed with gentle traction. This is usually performed at bedside. The hole is covered with a dressing. It heals on its own over a few days. Removal can be performed on both inpatients and outpatients with malfunctioning catheters. After the procedure, inpatients can return to their room, and outpatients may return home.
Tube Types
- Gastrostomy Tube (G Tube)
This tube extends through the belly wall directly into the stomach. It is the most frequently requested tube for patients who have difficulty eating and drinking.
- Gastrojejunostomy Tube (GJ Tube)
The tube extends through the belly wall, into the stomach, and continues through the stomach into the small bowel. This is the second most frequently requested tube for patients who eating and drinking. It is usually reserved for patients who have problems with food moving backwards from their stomach into their esophagus (gastroesophageal reflux), slowed emptying from their stomach (such as gastroparesis ), or those who didn’t tolerate feeding from a G tube.
- Jejunostomy Tube (J Tube)
This tube extends through the belly wall directly into a loop of small bowel. This is the least frequently requested tube. It is usually reserved for patients who have had stomach surgery or diseases. It is usually placed surgically but can infrequently be placed by Interventional Radiologists. However, if it becomes clogged or dislodged, it is usually replaced/revised by Interventional Radiology.
