Primary percutaneous gastrojejunostomy

What is a primary placed percutaneous gastrojejunostomy?

A primary percutaneous gastrojejunostomy tube is placed into your child's stomach as a means of feeding when he is unable to eat or tolerate oral or gastric feeds. The tube is placed into his stomach through the abdominal wall. The placement of the tube is done under image guidance, which means that images or pictures taken through ultrasound and x-ray are used to guide the placement of the tube.

The primary gastrojejunostomytube is usually placed under sedation or general anesthesia.

When might a primary percutaneous gastrojejunostomy be needed?

• for children with upper airway abnormalities
• for children with gastroesophageal reflux and aspiration
• for the fragile, complex pediatric patient

How should I prepare my child for a primary percutaneous gastrojejunostomy?

Some children may need to have an appointment in the pre-op clinic:

• You will meet with the pre-op nurse and anesthesiologist.
• Laboratory testing will be completed.
• Additional testing may be needed depending on your child's history.
• Prior to the procedure you will also meet an IR nurse practitioner, who will explain the procedure and provide instructions on care of the gastrojejunostomy tube.
• Please plan on at least two to four hours for the pre-op visit.

Your child may receive general anesthesia to help him stay still during the procedure. General anesthesia is medicine that causes deep sleep. The anesthesiologist will discuss this with you and obtain consent, either the day of the procedure or at a scheduled pre-operative visit.

Explain in simple terms why the procedure is needed and what will happen.

• Assure your child that you will be close by during the procedure.
• Your child may bring a favorite toy or blanket into the room.

All patients are admitted to the hospital after the procedure to start feeds. You can anticipate at least a 48 hours admission.

What should I expect when I bring my child to the hospital for a primary percutaneous gastrojejunostomy?

You will be instructed by the day surgery nurse or at the time of your pre-op visit

• where and when you will need to arrive for your procedure
• when your child should stop eating or drinking

The interventional radiologist will explain the procedure to you and your child. Before the procedure begins, you must sign a consent form. You must be your child's legal guardian to sign this form. If you are a legal guardian and not a parent, you must bring legal paperwork with you showing proof of legal guardianship.

What happens during a primary percutaneous gastrojejunostomy?

• You and your child will be brought into the room where the procedure is done. You may be able to stay until your child becomes drowsy or falls asleep.
• At the beginning of the procedure, the interventional radiologist will examine his upper abdomen using an ultrasound probe.
• A tube will be passed through his nose into his stomach and used to inject some air.
• After injecting some local anesthetic (numbing medication) into the skin, the interventional radiologist will use the x-ray monitor to guide the passage of a needle through the skin and into his stomach.
• A guide wire is then passed through the needle, which deploys the retention suture and the needle is removed.
• A catheter is then passed along the guide wire and advanced through the duodenum into the jejunum.
• The catheter is then exchanged for the gastrojejunostomy tube over the guide wire.

The procedure will take approximately two to three hours.

What happens after the primary percutaneous gastrojejunostomy?

• A nurse will take your child to the Interventional Radiology Post-Anesthesia Care Unit (PACU). You will be allowed to come to the recovery area.
• The nurse will monitor your child closely until your child is transferred to the floor.
• The interventional radiologist will speak with you about the procedure.

Is a primary percutaneous gastrojejunostomy safe?

Primary percutaneous gastrojejunostomy, when performed by an appropriately trained and experienced interventional radiologist, is a safe procedure which can usually be performed under sedation or general anesthesia. As with all invasive procedures, complications and side effects may occur. These will be explained to you in detail before you give your consent.

Your child will be exposed to ionizing radiation (x-rays) during the procedure. We believe that the benefit to your child's health outweighs the exposure that occurs during the primary percutaneous gastrojejunostomy. Because children are more sensitive to radiation exposure than adults, we have been leaders in adjusting equipment and procedures to deliver the lowest possible dose to young patients.

How do I learn the results of the primary percutaneous gastrojejunostomy?

The interventional radiologist will inform you of the results immediately after the procedure. If you have any questions, please speak to your child's doctor.