Placement of Gastrostomy (G), Gastro-jejunostomy (GJ), and Jejunostomy (J) Tubes

• Before G or GJ tube placement, patients will have blood work and a physical exam. Members of the care team meet with the family to complete paperwork and answer questions.
• The patient will change into a gown and is taken to an interventional radiology or operating room for the procedure. Depending on medical center policies, a parent may be able to go with the patient until time for the procedure.
• Children receive general anesthesia for the procedure.
• Ultrasound imaging is used to locate the liver and prevent injury to it.
• The care team wears gowns, masks, and gloves. A blue paper drape is used to cover the patient’s body except for the area of the incision of the abdomen. This helps keep the area clean and prevent infection.
• The stomach is inflated with air, usually through a nasogastric tube.
• Fluoroscopy is used to take images of the abdomen and select a site for the tube placement.
• The skin on the abdomen is cleaned. Then, the area is numbed using a local anesthetic to reduce pain. This is usually an injection of lidocaine.
• With the stomach inflated, 2-4 retention sutures or fasteners are used to hold the stomach to the wall of the abdomen. This creates a small area in the shape of a square or triangle. These sutures will be removed 10-14 days later.
• A hollow needle is inserted through the skin and into the stomach. A guide wire is inserted through the needle, and the needle is removed.
• Imaging is used to direct the guide wire to its correct position in the stomach or intestine.
• A small hollow device called a dilator is fitted over the guide wire and pushed through the skin and into the stomach to widen the opening. A series of dilators are used until the opening just fits the feeding tube.
• The feeding tube is then placed over the guide wire. Once the feeding tube is placed, a small balloon on the tube is filled with water to keep the tube in place against the stomach wall.
• When the feeding tube is in the correct position, the guide wire is removed.
• After the procedure, the skin is cleaned, and a dressing is placed over the site where the tube exits the skin.
• Patients spend a short time in recovery, usually about an hour.

Note: Procedures and surgical technique can vary depending on hospital policies, resources, expertise, and patient needs. Be sure to discuss your procedure with your care team.

• Before G or GJ tube placement, patients will have blood work and a physical exam. Members of the care team meet with the family to complete paperwork and answer questions.
• The patient will change into a gown and is taken to an operating room for the procedure. Depending on medical center policies, a parent may be able to go with the patient until time for the procedure.
• Patients receive general anesthesia and are closely monitored during the procedure.
• The care team wears gowns, masks, and gloves. A blue paper drape is used to cover the patient’s body except for the area of the incision of the abdomen. This helps keep the area clean and prevent infection.
• The skin on the abdomen is cleaned and prepped for surgery. A small incision is made in the area of the belly button. A thin surgical instrument with a small camera is inserted through the incision and used to provide live images of the stomach and surrounding organs.
• The surgeon will make 2-3 small incisions in the left upper abdomen. A surgical instrument is used to grasp the stomach and pull it up toward the abdominal wall. It is held in place with 2 sutures that create the area the feeding tube will be placed.
• The stomach is inflated with air through a nasogastric tube by the anesthesia team.
• A hollow needle is inserted through the skin and into the stomach at the location where the feeding tube will be placed under direct laparoscopic visualization. A guide wire is inserted through the needle into the stomach, and the needle is removed.
• A small hollow device called a dilator is fitted over the guide wire and pushed through the skin and into the stomach to widen the opening. A series of dilators are used until the opening just fits the feeding tube.
• The feeding tube is then placed over the guide wire. Once the feeding tube is placed, a small balloon on the tube is filled with water to keep the tube in place against the stomach wall.
• When the feeding tube is in the correct position, the guide wire is removed.
• Sutures are used to help keep the stomach in place against the abdominal wall.
• After the procedure, the skin is cleaned, and a dressing is placed over the site where the tube exits the skin.
• Patients spend a short time in recovery, usually about an hour.

Gastro-jejunostomy Feeding Tube Placement:

GJ tube placement follows the same general steps as G tube placement. However, fluoroscopy is used to advance the guide wire through the stomach and into its correct position in the jejunum. The GJ tube is then placed over the guide wire. Often, a GJ tube is placed after a G tube has been tried. If this is the case, the GJ tube is placed through the tract of the G tube.

Note: Procedures and surgical technique can vary depending on hospital policies, resources, expertise, and patient needs. Be sure to discuss your procedure with your care team.

• Before PEG tube placement, patients will have blood work and a physical exam. Members of the care team will meet with the family to complete paperwork and answer questions.
• The patient will change into a hospital gown.
• The procedure may be done in a treatment room or operating room.
• Patients receive general anesthesia and are closely monitored during the procedure.
• The care team will wear gowns, masks, and gloves. A blue paper drape is used to cover the patient’s body except for the area of the incision of the abdomen. This helps keep the area clean and prevent infection.
• The skin on the abdomen will be cleaned. Then, the area is numbed using a local anesthetic to reduce pain. This is usually an injection of lidocaine.
• The endoscope will be guided through the mouth, down the esophagus, and into the stomach. The light on the endoscope is used to identify the location of the tube site.
• Two main techniques are used to place the tube endoscopically:
  • Pull Method: Once the tube site is chosen, a hollow needle is inserted through the skin on the abdomen and into the stomach. Next, a guide wire is passed through the needle. The endoscope is used to attach to the wire and pull it up through the stomach, esophagus, and out through the mouth. Then, the feeding tube is place over the guide wire and moved down through the mouth and into the stomach. The tapered end of the tube is slowly pulled through the abdominal wall and out through a small incision.
  • Push Method: Once the tube site is chosen, a long needle is inserted through the skin on the abdomen and into the stomach. A guide wire is placed through the needle, and the feeding tube is pushed over the guide wire.
• Once the feeding tube is placed inside the stomach, a small balloon on the end is filled with water to keep the tube in place. When the feeding tube is in the correct position, the guide wire is removed. An external bumper or disc helps hold it in place on the outside of the skin.
• After the procedure, the skin will be cleaned, and a dressing will be placed over the site where the tube exits the skin.
• Endoscopy, fluoroscopy, or X-ray will be used to check the position of the feeding tube.
• Patients who receive general anesthesia will spend a short time in recovery, usually about an hour.

Note: Procedures and surgical technique can vary depending on hospital policies, resources, expertise, and patient needs. Be sure to discuss your procedure with your care team.