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Gastrostomy/Gastrojejunostomy
Brandt C. Wible, MD
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KEY FACTS

  • Preprocedure

    • Procedure

      • Post Procedure

        • Outcomes

          TERMINOLOGY

          • Abbreviations

            • Gastrostomy (G) tube
            • Gastrojejunostomy (GJ) tube
            • Jejunostomy (J) tube
          • Synonyms

            • Radiologically implanted gastrostomy (RIG)
            • Percutaneous radiologically guided gastrostomy (PRG)
            • Percutaneous endoscopic gastrostomy (PEG)
              • Radiologically placed tubes without use of endoscope often incorrectly referred to as PEG
          • Definitions

            • Gastrostomy: Creation of artificial external opening into stomach
              • May be created surgically, endoscopically, or percutaneously
              • Used to insert enteral tube terminating in stomach
            • Gastrojejunostomy: Creation of artificial external opening into stomach, insertion of enteral tube with end-ports in stomach and jejunum
              • Advantage over gastrostomy of low aspiration risk
              • Disadvantage of potential malposition or bowel obstruction
            • Gastropexy: Fixation of anterior stomach to abdominal wall
              • Gastric wall affixed percutaneously for stabilization during G-/GJ-tube procedures
            • Jejunostomy: Creation of artificial external opening into jejunum
              • Does not involve transgastric access
              • Used to directly insert enteral tube into jejunum
              • Manufacturer's G tube may be inserted via jejunostomy opening in some patients; in this case, tube should be referred to as J tube (not G tube)

          PREPROCEDURE

          • Indications

            • Contraindications

              • Preprocedure Imaging

                • Getting Started

                  PROCEDURE

                  • Patient Position/Location

                    • Equipment Preparation

                      • Procedure Steps

                        • Findings and Reporting

                          • Alternative Procedures/Therapies

                            POST PROCEDURE

                            • Continuous Care/Maintenance

                              • Things to Do

                                • Things to Avoid

                                  OUTCOMES

                                  • Problems

                                    • Complications

                                      • Expected Outcomes

                                        Selected References

                                        1. Dietrich CG et al: Percutaneous endoscopic gastrostomy - too often? Too late? Who are the right patients for gastrostomy? World J Gastroenterol. 26(20):2464-71, 2020
                                        2. Yasin JT et al: CT-guided gastrostomy tube placement-a single center case series. Diagn Interv Radiol. 26(5):464-9, 2020
                                        3. Gawande RS et al: MDCT evaluation of complications of percutaneous gastrostomy tube placement. Emerg Radiol. 26(6):663-74, 2019
                                        4. Hoang PT et al: Percutaneous gastrostomy tube placement: recognizing when things go wrong. Semin Intervent Radiol. 36(3):264-74, 2019
                                        5. Yuruker S et al: Percutaneous endoscopic gastrostomy: technical problems, complications, and management. Indian J Surg. 77(Suppl 3):1159-64, 2015
                                        6. Rahnemai-Azar AA et al: Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol. 20(24):7739-51, 2014
                                        7. Sabir SH et al: Early initiation of enteral feeding in cancer patients after outpatient percutaneous fluoroscopy-guided gastrostomy catheter placement. J Vasc Interv Radiol. 25(4):618-22, 2014
                                        8. Black MT et al: Subcutaneous T-fastener gastropexy: a new technique. AJR Am J Roentgenol. 200(5):1157-9, 2013
                                        9. Deen OJ et al: A novel procedure for gastrocutaneous fistula closure. J Clin Gastroenterol. 47(7):608-11, 2013
                                        10. Perona F et al: Percutaneous radiologic gastrostomy: a 12-year series. Gut Liver. 4 Suppl 1:S44-9, 2010
                                        11. Shin JH et al: Updates on percutaneous radiologic gastrostomy/gastrojejunostomy and jejunostomy. Gut Liver. 4 Suppl 1:S25-31, 2010
                                        12. Bechtold ML et al: Early versus delayed feeding after placement of a percutaneous endoscopic gastrostomy: a meta-analysis. Am J Gastroenterol. 103(11):2919-24, 2008
                                        13. Cantwell CP et al: Antibiotic prophylaxis for percutaneous radiologic gastrostomy and gastrojejunostomy insertion in outpatients with head and neck cancer. J Vasc Interv Radiol. 19(4):571-5, 2008
                                        14. Kim JW et al: The one-anchor technique of gastropexy for percutaneous radiologic gastrostomy: results of 248 consecutive procedures. J Vasc Interv Radiol. 19(7):1048-53, 2008
                                        15. Schrag SP et al: Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis. 16(4):407-18, 2007
                                        16. Given MF et al: Interventional radiology techniques for provision of enteral feeding. Cardiovasc Intervent Radiol. 28(6):692-703, 2005
                                        17. Given MF et al: The role of the interventional radiologist in enteral alimentation. Eur Radiol. 14(1):38-47, 2004
                                        18. Lyon SM et al: De novo placement of button gastrostomy catheters in an adult population: experience in 53 patients. J Vasc Interv Radiol. 14(10):1283-9, 2003
                                        19. Pearce CB et al: Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. Postgrad Med J. 78(918):198-204, 2002
                                        20. Ho SG et al: Radiological percutaneous gastrostomy. Clin Radiol. 56(11):902-10, 2001
                                        21. Thornton FJ et al: Percutaneous gastrostomy in patients who fail or are unsuitable for endoscopic gastrostomy. Cardiovasc Intervent Radiol. 23(4):279-84, 2000
                                        22. Ryan JM et al: Percutaneous gastrostomy with T-fastener gastropexy: results of 316 consecutive procedures. Radiology. 203(2):496-500, 1997
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Preprocedure

                                          • Procedure

                                            • Post Procedure

                                              • Outcomes

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Gastrostomy (G) tube
                                                  • Gastrojejunostomy (GJ) tube
                                                  • Jejunostomy (J) tube
                                                • Synonyms

                                                  • Radiologically implanted gastrostomy (RIG)
                                                  • Percutaneous radiologically guided gastrostomy (PRG)
                                                  • Percutaneous endoscopic gastrostomy (PEG)
                                                    • Radiologically placed tubes without use of endoscope often incorrectly referred to as PEG
                                                • Definitions

                                                  • Gastrostomy: Creation of artificial external opening into stomach
                                                    • May be created surgically, endoscopically, or percutaneously
                                                    • Used to insert enteral tube terminating in stomach
                                                  • Gastrojejunostomy: Creation of artificial external opening into stomach, insertion of enteral tube with end-ports in stomach and jejunum
                                                    • Advantage over gastrostomy of low aspiration risk
                                                    • Disadvantage of potential malposition or bowel obstruction
                                                  • Gastropexy: Fixation of anterior stomach to abdominal wall
                                                    • Gastric wall affixed percutaneously for stabilization during G-/GJ-tube procedures
                                                  • Jejunostomy: Creation of artificial external opening into jejunum
                                                    • Does not involve transgastric access
                                                    • Used to directly insert enteral tube into jejunum
                                                    • Manufacturer's G tube may be inserted via jejunostomy opening in some patients; in this case, tube should be referred to as J tube (not G tube)

                                                PREPROCEDURE

                                                • Indications

                                                  • Contraindications

                                                    • Preprocedure Imaging

                                                      • Getting Started

                                                        PROCEDURE

                                                        • Patient Position/Location

                                                          • Equipment Preparation

                                                            • Procedure Steps

                                                              • Findings and Reporting

                                                                • Alternative Procedures/Therapies

                                                                  POST PROCEDURE

                                                                  • Continuous Care/Maintenance

                                                                    • Things to Do

                                                                      • Things to Avoid

                                                                        OUTCOMES

                                                                        • Problems

                                                                          • Complications

                                                                            • Expected Outcomes

                                                                              Selected References

                                                                              1. Dietrich CG et al: Percutaneous endoscopic gastrostomy - too often? Too late? Who are the right patients for gastrostomy? World J Gastroenterol. 26(20):2464-71, 2020
                                                                              2. Yasin JT et al: CT-guided gastrostomy tube placement-a single center case series. Diagn Interv Radiol. 26(5):464-9, 2020
                                                                              3. Gawande RS et al: MDCT evaluation of complications of percutaneous gastrostomy tube placement. Emerg Radiol. 26(6):663-74, 2019
                                                                              4. Hoang PT et al: Percutaneous gastrostomy tube placement: recognizing when things go wrong. Semin Intervent Radiol. 36(3):264-74, 2019
                                                                              5. Yuruker S et al: Percutaneous endoscopic gastrostomy: technical problems, complications, and management. Indian J Surg. 77(Suppl 3):1159-64, 2015
                                                                              6. Rahnemai-Azar AA et al: Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol. 20(24):7739-51, 2014
                                                                              7. Sabir SH et al: Early initiation of enteral feeding in cancer patients after outpatient percutaneous fluoroscopy-guided gastrostomy catheter placement. J Vasc Interv Radiol. 25(4):618-22, 2014
                                                                              8. Black MT et al: Subcutaneous T-fastener gastropexy: a new technique. AJR Am J Roentgenol. 200(5):1157-9, 2013
                                                                              9. Deen OJ et al: A novel procedure for gastrocutaneous fistula closure. J Clin Gastroenterol. 47(7):608-11, 2013
                                                                              10. Perona F et al: Percutaneous radiologic gastrostomy: a 12-year series. Gut Liver. 4 Suppl 1:S44-9, 2010
                                                                              11. Shin JH et al: Updates on percutaneous radiologic gastrostomy/gastrojejunostomy and jejunostomy. Gut Liver. 4 Suppl 1:S25-31, 2010
                                                                              12. Bechtold ML et al: Early versus delayed feeding after placement of a percutaneous endoscopic gastrostomy: a meta-analysis. Am J Gastroenterol. 103(11):2919-24, 2008
                                                                              13. Cantwell CP et al: Antibiotic prophylaxis for percutaneous radiologic gastrostomy and gastrojejunostomy insertion in outpatients with head and neck cancer. J Vasc Interv Radiol. 19(4):571-5, 2008
                                                                              14. Kim JW et al: The one-anchor technique of gastropexy for percutaneous radiologic gastrostomy: results of 248 consecutive procedures. J Vasc Interv Radiol. 19(7):1048-53, 2008
                                                                              15. Schrag SP et al: Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis. 16(4):407-18, 2007
                                                                              16. Given MF et al: Interventional radiology techniques for provision of enteral feeding. Cardiovasc Intervent Radiol. 28(6):692-703, 2005
                                                                              17. Given MF et al: The role of the interventional radiologist in enteral alimentation. Eur Radiol. 14(1):38-47, 2004
                                                                              18. Lyon SM et al: De novo placement of button gastrostomy catheters in an adult population: experience in 53 patients. J Vasc Interv Radiol. 14(10):1283-9, 2003
                                                                              19. Pearce CB et al: Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. Postgrad Med J. 78(918):198-204, 2002
                                                                              20. Ho SG et al: Radiological percutaneous gastrostomy. Clin Radiol. 56(11):902-10, 2001
                                                                              21. Thornton FJ et al: Percutaneous gastrostomy in patients who fail or are unsuitable for endoscopic gastrostomy. Cardiovasc Intervent Radiol. 23(4):279-84, 2000
                                                                              22. Ryan JM et al: Percutaneous gastrostomy with T-fastener gastropexy: results of 316 consecutive procedures. Radiology. 203(2):496-500, 1997