eMedicine Specialties > Radiology > Vascular/Interventional

Percutaneous Gastrostomy and Jejunostomy: Multimedia

Author: Richard Duszak Jr, MD, Consulting Staff, Department of Radiology, Baptist Memorial Hospitals
Contributor Information and Disclosures

Updated: Dec 23, 2008

Multimedia

Direct percutaneous gastrostomy tube placement en...
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Media file 1: Direct percutaneous gastrostomy tube placement entails placement of a feeding catheter directly into the stomach by using imaging guidance. A balloon catheter is illustrated.
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Direct percutaneous gastrostomy tube placement en...

Direct percutaneous gastrostomy tube placement entails placement of a feeding catheter directly into the stomach by using imaging guidance. A balloon catheter is illustrated.

Also called transgastric jejunostomy, gastrojejun...
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Media file 2: Also called transgastric jejunostomy, gastrojejunostomy tube placement entails the placement of a feeding tube through the stomach and duodenum, with the tip terminating in the jejunum. This method combines the simplicity of gastric access with the benefits of direct small-bowel tube feedings.
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Also called transgastric jejunostomy, gastrojejun...

Also called transgastric jejunostomy, gastrojejunostomy tube placement entails the placement of a feeding tube through the stomach and duodenum, with the tip terminating in the jejunum. This method combines the simplicity of gastric access with the benefits of direct small-bowel tube feedings.

Percutaneous jejunostomy entails the placement of...
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Media file 3: Percutaneous jejunostomy entails the placement of a feeding tube directly into the small bowel. This method is technically more difficult than percutaneous gastrostomy and is associated with a higher risk.
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Percutaneous jejunostomy entails the placement of...

Percutaneous jejunostomy entails the placement of a feeding tube directly into the small bowel. This method is technically more difficult than percutaneous gastrostomy and is associated with a higher risk.

An abdominal photograph is superimposed on an abd...
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Media file 4: An abdominal photograph is superimposed on an abdominal radiograph in the same patient to illustrate the important landmarks for gastric puncture. The margin of the left hepatic lobe is marked on the skin (curved solid line) by using ultrasonographic guidance, and the course of the superior epigastric artery (dotted vertical line) is traced by using a Doppler technique. A metal marker overlies the intended access tract into the gastric body and antral junction.
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An abdominal photograph is superimposed on an abd...

An abdominal photograph is superimposed on an abdominal radiograph in the same patient to illustrate the important landmarks for gastric puncture. The margin of the left hepatic lobe is marked on the skin (curved solid line) by using ultrasonographic guidance, and the course of the superior epigastric artery (dotted vertical line) is traced by using a Doppler technique. A metal marker overlies the intended access tract into the gastric body and antral junction.

With anterior fluoroscopy alone, the depth of the...
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Media file 5: With anterior fluoroscopy alone, the depth of the needle cannot be determined when gastric access is achieved. With lateral or steep oblique fluoroscopic imaging, the anterior gastric wall is shown as being indented (red marks on the right) just before the needle enters the gastric lumen.
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With anterior fluoroscopy alone, the depth of the...

With anterior fluoroscopy alone, the depth of the needle cannot be determined when gastric access is achieved. With lateral or steep oblique fluoroscopic imaging, the anterior gastric wall is shown as being indented (red marks on the right) just before the needle enters the gastric lumen.

Gastropexy anchors help secure the anterior gastr...
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Media file 6: Gastropexy anchors help secure the anterior gastric wall to the anterior abdominal wall during tract dilatation and balloon gastrostomy tube placement. Cope gastric anchors are illustrated here (bottom right), just inferior to the gastrostomy retention balloon.
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Gastropexy anchors help secure the anterior gastr...

Gastropexy anchors help secure the anterior gastric wall to the anterior abdominal wall during tract dilatation and balloon gastrostomy tube placement. Cope gastric anchors are illustrated here (bottom right), just inferior to the gastrostomy retention balloon.

Commonly used by radiologists, Cope loop catheter...
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Media file 7: Commonly used by radiologists, Cope loop catheters (illustrated with a metal introducer stiffener) are easily placed into the stomach. However, their small lumina and small side holes predispose them to catheter occlusion.
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Commonly used by radiologists, Cope loop catheter...

Commonly used by radiologists, Cope loop catheters (illustrated with a metal introducer stiffener) are easily placed into the stomach. However, their small lumina and small side holes predispose them to catheter occlusion.

Commonly used for surgical, endoscopic, and radio...
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Media file 8: Commonly used for surgical, endoscopic, and radiologic gastrostomy access, balloon catheters provide secure intraluminal retention and are simple to place and replace.
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Commonly used for surgical, endoscopic, and radio...

Commonly used for surgical, endoscopic, and radiologic gastrostomy access, balloon catheters provide secure intraluminal retention and are simple to place and replace.

When gastrostomy tubes are dislodged, the sinus t...
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Media file 9: When gastrostomy tubes are dislodged, the sinus tract (top right) can be readily identified and recanalized for up to several days. With sinus tracts of this diameter, feeding tubes can often be reinserted directly. When tracts are narrower, angiographic catheters and wires are often used, and tract dilatation may be necessary for tube replacement.
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When gastrostomy tubes are dislodged, the sinus t...

When gastrostomy tubes are dislodged, the sinus tract (top right) can be readily identified and recanalized for up to several days. With sinus tracts of this diameter, feeding tubes can often be reinserted directly. When tracts are narrower, angiographic catheters and wires are often used, and tract dilatation may be necessary for tube replacement.

Jejunostomy tube replacement. After tube dislodge...
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Media file 10: Jejunostomy tube replacement. After tube dislodgement, jejunostomy tracts may close more rapidly than gastrostomy tracts. This narrowed sinus tract required dilatation and peel-away sheath placement (left) to allow placement of a silicone balloon catheter (right).
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Jejunostomy tube replacement. After tube dislodge...

Jejunostomy tube replacement. After tube dislodgement, jejunostomy tracts may close more rapidly than gastrostomy tracts. This narrowed sinus tract required dilatation and peel-away sheath placement (left) to allow placement of a silicone balloon catheter (right).

Regarding tube-site infections, most catheter-rel...
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Media file 11: Regarding tube-site infections, most catheter-related infections involve local cellulitis, as shown here, with erythema and tenderness. These infections frequently respond to local wound care and oral antibiotics.
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Regarding tube-site infections, most catheter-rel...

Regarding tube-site infections, most catheter-related infections involve local cellulitis, as shown here, with erythema and tenderness. These infections frequently respond to local wound care and oral antibiotics.

More on Percutaneous Gastrostomy and Jejunostomy

References
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Further Reading

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Keywords

percutaneous gastrostomy, gastrostomy, jejunostomy, feeding tube, tube feeding, G tube, G-tube, J tube, J-tube, GJ tube, GJ-tube, enteral tube, enteral access, enterostomy, percutaneous endoscopic gastrostomy, PEG

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Contributor Information and Disclosures

Author

Richard Duszak Jr, MD, Consulting Staff, Department of Radiology, Baptist Memorial Hospitals
Richard Duszak Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Radiology, American Medical Association, American Roentgen Ray Society, Radiological Society of North America, Society of Interventional Radiology, Tennessee Medical Association, and Tennessee Radiological Society
Disclosure: Nothing to disclose.

Medical Editor

Fredric A Hoffer, MD, FAAP, FSIR, Professor of Radiology, University of Washington; Section Chief of Interventional Radiology, Department of Radiology, Seattle Children's Hospital and Regional Medical Center
Fredric A Hoffer, MD, FAAP, FSIR is a member of the following medical societies: American Academy of Pediatrics, Children's Oncology Group, Radiological Society of North America, Society for Pediatric Radiology, and Society of Interventional Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Douglas M Coldwell, MD, PhD, Professor and Chief of Interventional Radiology, Professor of Radiology and Surgery, University of Missouri at Columbia
Douglas M Coldwell, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American College of Radiology, American Heart Association, American Physical Society, American Roentgen Ray Society, Society of Cardiovascular and Interventional Radiology, Southwest Oncology Group, and Special Operations Medical Association
Disclosure: Sirtex, Inc. Consulting fee Speaking and teaching

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Kyung J Cho, MD, FACR, William Martel Professor of Radiology, Interventional Radiology Fellowship Director, University of Michigan Health System
Kyung J Cho, MD, FACR is a member of the following medical societies: American College of Radiology, American Heart Association, American Medical Association, American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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