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

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

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:

Image-guided
Surgical
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 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.

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.

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.

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.

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.

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.

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.

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Reviewed: December 2018