Percutaneous gastrostomy insertion

Percutaneous gastrostomy is a technique where a narrow plastic tube is placed through the skin, directly into your stomach, to give you liquid nutrition. Because it is done through the skin, it is called percutaneous, and gastrostomy means making an opening into the stomach.

There are several reasons why you may not be able to eat normally. There may be a blockage at the back of your throat or in your gullet (oesophagus), and this is preventing food going down normally. It may be that you have a neurological condition or another medical issue which causes problems with your swallowing. In order to get the nutrition that you need the doctor has recommended you get fed directly into your stomach.

The Consultant in charge of your case, and the Interventional Radiologist (the doctor who specialises in Imaging Procedures) who will be carrying out the Gastrostomy.They will have discussed the situation, and feel that this is the best option for you. However, you will also have the opportunity for your opinion to be taken into account and if, after discussion with your doctors, you do not want the procedure carried out, then you can decide against it.

A specialist doctor called an Interventional Radiologist. Interventional Radiologists are experts in using X-ray equipment and in microsurgical techniques.

In the Imaging Department, in a special Interventional Radiology (IR) Procedure Room which is designed for these specialised procedures. You will be checked into the department by a nurse, who will ask some medical questions and fill out some paperwork. The Interventional Radiologist will then come and talk to you about the procedure. You will have the opportunity to ask any questions or raise any concerns, and only if you are happy to continue with the procedure will you be asked to sign the consent form.

It is performed in the IR procedure room.

• You will lie on a special x-ray table on your back and be covered with sterile drapes.
• You will have a needle put into a vein in your arm so we can administer antibiotics, pain killers and sedation if required.
• The radiologist will pass a small tube down your nose into your stomach. This is called a naso-gastric tube (NGT). You may already have one of these in place when you arrive to the department, and if this is the case we can use this one for the procedure.During the procedure a nurse will inject air into the tube to inflate the stomach. This will make you feel full.
• The radiologist will then clean the skin below your ribs and cover you in sterile drapes, and then he or she will inject local anaesthetic.
• Then the doctor will place 2-3 small anchor sutures. These hold the stomach up against the abdominal wall so that it is safe to place the feeding tube (these sutures will fall out after a couple of weeks).
• Then a needle is placed between these sutures and a small wire placed through the needle. The needle is removed and a plastic tube is inserted to dilate the size of the hole.
• Once this is done the feeding tube will be inserted and sterile water injected into the balloon of the tube (this holds the tube in place). Once the tube is in the correct position a small dressing will be applied.

To prepare for the procedure you will need to make sure you do the following:

You will need to have a blood test before your procedure. Please let us know if you are taking any antiplatelet medicines (for example, Aspirin, Clopidogrel) or any medicines that thin the blood (for example, Warfarin), as these may need to be stopped temporarily before the procedure. Call the IR department for advice as soon as you get your appointment letter on 01273 696955 Extension. 64240/64278 and ask to speak to one of the IR nursing team.

If you are taking medicines for diabetes (for example metformin) or using insulin, then these may need to be altered around the time of the procedure. Call the IR department on the numbers above for advice as soon as you get your appointment letter.

You cannot eat or drink anything (except water) for four hours before your procedure. You can drink water up to two hours before your procedure.

You will be admitted to a hospital ward after the procedure for observation and to be seen by a dietician.