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This leaflet tells you about the procedure known as percutaneous gastrostomy. It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor but can serve as a starting point for such a discussion.
What is a percutaneous gastrostomy?
Percutaneous gastrostomy is a technique whereby a narrow plastic tube is placed through the skin, directly into your stomach. Once in place the tube can be used to give you liquid food directly into your stomach, to provide nutrition. Because it is done through the skin, it is called percutaneous, and gastrostomy means making an opening into the stomach.
Who will be doing the percutaneous gastrostomy?
A specially trained doctor called a radiologist will perform the procedure. Radiologists have special expertise in using x-ray and scanning equipment and also in interpreting the images produced. They need to look at these images whilst carrying out the procedure.
Where will the procedure take place?
The procedure is generally carried out in the x-ray department, in a room adapted for this sort of specialised procedure.
How do I prepare for percutaneous gastrostomy?
You need to be an in-patient in the hospital. You will be asked to put on a hospital gown. If you have any allergies you must let your doctor know. If you have ever reacted to intravenous contrast medium, the dye used in x-ray departments for kidney x-rays and CT scanning, you must also tell your doctor about this.
What actually happens during a percutaneous gastrostomy?
You will lie on the x-ray table, flat on your back. You will have a monitoring device attached to your finger and will possibly receive oxygen. You will also have a monitoring device attached to your chest, and a blood pressure cuff to your arm. The radiologist will keep everything sterile and will wear a theatre gown and operating gloves. Your skin will be cleaned with antiseptic and most of the rest of your body covered with a theatre towel. The radiologist will use the x-ray equipment or an ultrasound machine to decide on the most suitable point for inserting the feeding tube. The skin will be anaesthetised with local anaesthetic. This can sting a little to start with, but rapidly wears off. The radiologist will then pass a thin, hollow needle into your stomach using x-rays or ultrasound as a guide.
Once the needle is in your stomach, some air will be put in, which makes room for a guidewire to be placed down through the needle into your stomach. The needle is then removed, leaving the guidewire in place, and then a series of small tubes are passed over the wire, one after another, to enlarge the pathway from the skin into your stomach. Once this pathway is wide enough, a tube (catheter) can be put in through the skin and into your stomach over the guidewire. The guidewire is then removed. The tube will be used to give you food, and is large enough to ensure that you receive adequate nutrition.
Will it hurt?
Unfortunately, while the procedure is being done, it may hurt for a short period of time, but any pain that you have will be controlled with painkillers. When the local anaesthetic is injected it will sting to start with, but this soon wears off, and the skin and deeper tissues should then feel numb. Later you will be aware of the tubes being passed into your stomach, but this should just be a feeling of pressure and not pain. Someone will be looking after you. Generally, placing the catheter in the stomach takes only a short time and once in place it should not hurt at all.
How long will it take?
Every patient’s situation is different and it is not always easy to predict how complex or how straightforward the procedure will be, but for an initial insertion we allow 1 hour, for a tube exchange we allow 30 minutes.
What happens afterwards?
You will be taken back to your ward on your bed. Staff on the ward will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems. If you have been up and about previously, then you will generally need to stay in bed for 3 hours afterwards, until you have recovered. It is important to try and look after the feeding tube. You should try not to make any sudden movements, for example getting up out of a chair or out of bed without remembering the tube. However, you will be able to lead a perfectly normal life with
the tube in place.
How long will the tube stay in and what happens next?
This is a question which can only be answered by the doctors looking after you. It all depends on why you needed the tube in the first place. You do need to discuss this fully with your consultant. The tube needs to stay in place until you can eat and drink normally, and in some cases this might not be for a very long time. You will have a specially trained dietician looking after you, who will decide how much liquid food you need to put down the tube and will show you how to look after the tube properly. They will also give you more information about the type of liquid food you are receiving. About 2-3 weeks after the procedure the external stitches will come away by themselves. The tube should then stay in all by itself.
Are there are risks or complications?
Percutaneous gastrostomy is a very safe procedure. However, there are some risks and complications that can arise, as with any medical treatment. The biggest problem could be not being able to get the tube into your stomach. This can sometimes happen if you have not been able to eat for a long time and your stomach has shrunk quite a lot. It may not be possible to find it with a small needle. If this happens you may need an operation to place the tube. Sometimes there is a leak around the tube. This is less likely to happen if the stomach has been attached to the muscles beneath the skin, but it can still sometimes occur. This can lead to the skin around the tube becoming very red and sore. An attempt will be made to treat this but it may become necessary to remove the tube for healing to occur. You need to keep the area around the tube very clean and very dry.
Very rarely a blood vessel can be punctured accidentally when passing the needle into the stomach. This can result in bleeding. This may stop by itself, or if not, you may need a blood transfusion. Occasionally it may require another procedure to block the bleeding vessel. This would be done by a radiologist using a fine plastic tube put into the vessel. Very rarely, it may need an operation to stop the bleeding. However, this is a very rare complication.
Some of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure, before you sign the consent form. Percutaneous gastrostomy is considered a very safe procedure, designed to save
you having a larger operation. There are some slight risks and possible complications involved, and although it is difficult to say exactly how often these occur, they are generally minor and do not happen very often.
Please remember that this leaflet is intended as general information only. It is not definitive, and the RCR and the BSIR cannot accept any legal liability arising from its use. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please therefore always check specific advice on the procedure or any concerns you may have with your doctor.