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Placement of G Tube, J Tube, and GJ Tube

G tubes, GJ tubes, and J tubes are placed through a small opening called a stoma that is made in the wall of the abdomen. The procedure to create the opening is called an ostomy. A feeding tube ostomy procedure may be done 3 main ways:

  1. Image-guided
  2. Surgical
  3. Endoscopic

The type of procedure will depend on several factors including hospital resources, medical team expertise, patient health factors, and whether the patient is having other procedures or surgery.

If the feeding tube is placed using general anesthesia, patients may be told not eat or drink anything by mouth for a specified amount of time before the procedure. It is very important to follow these NPO instructions.

Patients usually stay in the hospital overnight for observation and pain control. The care team will give specific NPO instructions after feeding tube placement. There may be a change in medicines during recovery and/or after gastrostomy. Families should discuss any changes in medication in administration or schedule. Fluids and enteral feedings will be started slowly to make sure that the feeding tube works properly and to help the digestive system adjust.

Complications After Gastrostomy, Gastro-jejunostomy, and Jejunostomy

Placement of a feeding tube is a common procedure during cancer treatment. However, there are always risks involved with anesthesia and surgical procedures. A doctor will explain the details of the procedure and discuss the risk and benefits. It is important to follow all care instructions to reduce risk of infection and keep the feeding tube working properly.

The main risks during insertion include problems with anesthesia or injury to nearby organs. After the feeding tube is placed, the most common complications are movement of the tube out of position, tube blockage or leakage, digestive problems, skin problems around the tube, and infection.

Serious complications are rare, but they do occur. Be sure to ask questions, and follow all instructions given by the care team. Check with your doctor about any changes to medicines after feeding tube placement.

Diagram of a Jejunostomy Tube placed through the abdomen and into the stomach.

Imagery Guided Gastrostomy and Gastro-jejunostomy

Imagery guided gastrostomy uses fluoroscopy to guide feeding tube placement through the abdomen and into the stomach. This method is also known as percutaneous radiologic gastrostomy (PRG). In this procedure, a live X-ray of the stomach and abdomen is shown on a video monitor so the radiology team can view the procedure as it is done. The initial tube is usually a long tube, but it may be changed for a low-profile device after healing. Sometimes, a low-profile may be placed initially.

A medical illustration of the placement of a gastrostomy tube (G Tube) and a gastrostomy-jejunostomy tube (GJ Tube)

Surgical Gastrostomy, Gastrojejunostomy, and Jejunostomy

Surgical feeding tube placement (G tube, GJ tube, or J tube) is performed in the operating room while the patient is under general anesthesia. The feeding tube is placed directly through the stomach wall ending in the stomach (G tube) or small intestine (GJ tube). A jejunostomy (J) tube is placed directly through the wall of the intestine. These tubes are usually low profile or button devices. If a long tube is placed initially, it may be replaced with a low profile device after the tract heals in 6 weeks.

The surgery may be minimally-invasive (laparoscopic) using several small incisions or open surgery using a larger incision. In laparoscopic surgery, a tiny camera is inserted to guide the procedure. In an open procedure, a larger incision is made through the abdominal wall to access the stomach or intestine.

In general, laparoscopic G tube placement is preferred over open surgery. However, open surgery may be needed if there are adhesions, scar tissue, or disease-related factors. The total time for the procedure is usually about 1-2 hours with anesthesia and recovery.

Percutaneous Endoscopic Gastrostomy (PEG)

Percutaneous endoscopic gastrostomy (PEG) is the placement of a feeding tube using an endoscope. An endoscope is a thin, long, flexible instrument with a camera and light attached to the end. The endoscope is moved through the mouth, down the esophagus, and into the stomach. A video monitor shows a picture of the inside of the stomach so that the feeding tube can be placed in the correct position. The feeding tube is passed from the stomach to the outside of the skin through a small incision in the abdomen. The procedure is usually performed under general anesthesia. The total time for the procedure is usually about 1-2 hours with anesthesia and recovery. The PEG is usually a long tube, but it may be changed for a low-profile device after the tract heals.

Reviewed: December 2018