About percutaneous gastrostomy

Percutaneous gastrostomy is a plastic tube that passes directly through your abdominal wall into your stomach.  It allows liquid food to be given to patients who are unable to swallow or feed in the normal way.

Percutaneous means ‘through the skin’.  Gastrostomy means it goes ‘into the stomach’.

Why we offer percutaneous gastrostomy

We offer percutaneous gastrostomy insertion to patients who are unable eat in the normal way. This might be for the following reasons:

  • There is a physical blockage to the passage of food from their mouth to their stomach.
  • Their muscles required for normal eating and swallowing have become weak or uncoordinated. This is usually seen following strokes, serious brain injuries or with neurological disorders such as multiple sclerosis and motor neurone disease.

If your eating problem is temporary, we may be able to give you liquid food into your stomach via a ‘nasogastric tube’.  This is a tube which passes via your nose, through your food pipe (oesophagus) and into your stomach. This avoids the need for an incision (cut) into your abdomen, but is only appropriate for short term use.

If you need longer term feeding, we recommend a percutaneous gastrostomy.

Why you need percutaneous gastrostomy

Your consultant and interventional radiologist feel that this is the best feeding option for you. A dietician, who specialises in feeding and nutrition, will also have contributed to the decision.

They will discuss their recommendation with you and they will take your opinion into account. You will have the chance to ask questions.  If, after discussion with your doctors, you do not want us to carry out the procedure, you can decide against it.

We will only go ahead with this procedure after you have given us your written consent.

Who performs the procedure and where it takes place

An interventional radiologist will perform the procedure. These doctors have expertise in manipulating equipment remotely from outside the body using X ray and scanning equipment, and interpreting the images produced.  They use these images on screen to guide the procedure and manoeuvre the gastrostomy into the correct place.

We will perform the procedure in the Interventional Screening Room, part of the Kingston Hospital Radiology Department.

Preparing for your procedure

It is likely that you are already an inpatient in the hospital.

To prepare for the procedure, do the following.

  • You can take sips of water up to 2 hours before the procedure.
  • You can take your normal medicines up until the procedure.
  • When you receive your appointment letter, tell the Interventional Radiology Unit if you have previously had allergies to foods, medicines or intravenous contrast medium (the dye used for kidney X rays and CT scans).
  • When you receive your appointment letter, tell the Interventional Radiology Unit if you have been on blood thinning tablets such as warfarin, aspirin or clopidogrel.  [Amanda, cut these two bullets, or add a separate section for outpatient cases and put them there – as we have done with eg percutaneous fluid drainage?].
  • We may give you some pre-procedural painkillers and antibiotics if you need them.

Before the procedure your radiology doctor will position a nasogastric tube if you do not already have one.  A nasogastric tube is a thin, flexible tube that we pass through your nostril and into your stomach.

We will also place an intravenous cannula (a small flexible tube with a needle on the end) in a vein on your arm, in case you need any medicines.

During the procedure you can expect the following.

When you arrive in the department you will meet the team, including your nurse, the interventional radiologist and the radiographer.  The radiographer operates the imaging equipment and is responsible for the images obtained.

  • We will ask you to lie on your back on the X ray table.
  • We will wrap a cuff around your arm to monitor your blood pressure, and put a clip on your finger to measure your pulse and breathing.
  • We will clean the skin of your upper abdomen with antiseptic solution and inject it with local anaesthetic to make it go numb. Through this numb patch, the radiologist will pass a long thin wire into your stomach via a needle. This wire maintains a route into the stomach from the outside and is used as a guide, over which the gastrostomy tube slides into position.
  • When the radiologist is satisfied with the position of the gastrostomy tube, they will secure it and cover it with dressings.

How long it takes

Every patient’s situation is different, but you can expect to be in the room for approximately 1 hour. Most of this time is taken up with preparation.  It takes about 5 minutes to insert the tube. 

Pain

  • When we anaesthetise your skin and deeper tissues with local anaesthetic, this will sting for a few seconds and then the area will go numb.
  • Most patients only experience minor discomfort, but everyone's experience of pain is different.
  • If the procedure does become uncomfortable, a nurse or another member of our clinical staff will arrange for you to have painkillers through a needle in your arm, directly into your blood stream.

After the procedure

After the procedure, we will transfer you back to the ward. It is important that you remain comfortable and lie quietly in bed for several hours. Your nurse will keep a close eye on your pulse, blood pressure and breathing, to ensure you are recovering as expected.

Your stomach must remain empty for 6 hours following the procedure, prior to starting feeds. Your doctors will examine your tummy daily to check you are recovering well.

If you recover well, we will start feeding you liquid food 12 hours after the procedure.

Risks

Gastrostomy insertion is a straightforward and safe procedure, but risks and complications can arise. These include the following.

  • Stomach contents and air can leak around the tube into the lining of your tummy, causing peritonitis. This can make you ill and you will require urgent surgery.
  • If your stomach is in an unusual position, we may not be able to place a tube.
  • A blood vessel can be punctured accidentally when we pass the needle into your stomach, causing bleeding.  This is rare.  If it happens you might require a blood transfusion or if more serious, you will need an operation to control the bleeding.
  • The tube is held in place by an inflatable balloon at its end. This balloon sits inside your stomach and acts as an anchor. If it is pulled hard, the tube can fall out.

Looking after your tube

Avoid creating tension on your tube

If the tube is pulled out, go to your nearest Emergency Department (A&E) so that we can place another tube through the same track, before it closes up [Amanda: how long does it take to close up – ie how urgent is this?]

Long-term care of your tube

Many patients need gastrostomy feeding long term or over prolonged periods, but this depends on individual circumstances.

We will need to change your tube every few months, to prevent it getting blocked with food residues.

This is usually a simple procedure that health workers can perform in your home.

Contact information

Interventional Radiology Unit
 

Interventional Radiology Unit Charge Nurse​​​​​​​

Telephone:

Interventional Radiology Unit: 020 8934 6206

Interventional Radiology Unit Charge Nurse: 020 8934 2758