Gastrointestinal Interventions

Session: Educational Exhibit Presentations - Station 4: Gastrointestinal Interventions

Gastrostomy and Gastrojejunostomy Tube Exchange—Know What Can Go Wrong!

Monday, March 6, 2023

5:55 PM – 6:00 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

KG

Klaudio Gjeluci, MD

Resident, Department of Radiology
University of Cincinnati Medical Center

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Ali Kord, MD, MPH

Assistant Professor of Radiology
University of Cincinnati Medical Center
RL

Richard X. Liu, MHS

Medical Student
University of Cincinnati College of Medicine
SK

Stephanie H. Kim, MD, PhD

Assistant Professor of Radiology
University of Cincinnati Medical Center
SS

Sandeep Sharma, MD

Assistant Professor of Radiology
University of Cincinnati
RR

Ross .. Ristagno, MD

Associate Professor of Radiology
University of Cincinnati

Disclosure(s):

Klaudio Gjeluci, MD: No financial relationships to disclose

Ali Kord, MD, MPH: No financial relationships to disclose

Richard X. Liu, MHS: No financial relationships to disclose

Learning Objectives:

To discuss common types of gastrostomy (G) and gastrojejunostomy (GJ) tubes that are placed percutaneously, endoscopically, and surgically

Present a case-based review of challenging G and GJ tube exchanges

Provide appropriate management recommendations to overcome or avoid problems encountered with G and GJ exchanges

Background:

Enteric tube maintenance is a more frequent procedure encountered in IR than initial percutaneous feeding tube placement. Enteric tube evaluation, exchange, and revision are necessary to support an IR practice. Percutaneous exchange of G and GJ tubes is not uniformly simple. We aim to equip IR trainees with knowledge regarding the management of G and GJ tubes, particularly those placed by other specialties.

Clinical Findings/Procedure Details:

This exhibit provides IR trainees with required information regarding available IR and non-IR enteric tubes and how to troubleshoot challenging enteric tube exchanges. The topics include:

Management options for newly placed G or GJ tubes in the setting of dislodgement or requested exchange

Difficult or impossible G to GJ conversions

Troubleshooting malpositioned or retracted G and GJ tubes

Techniques to exchange occluded G and GJ tubes

Conversion to a button-type G tube

Exchanging pull-type G tubes: Ponsky pulls need not be painful

Soft tissue infections and granulation tissue presentations and treatment

Pericatheter leaks and enlarging stoma: short-term and long-term issues

Colocutaneous fistula is identified during exchange, what should be done now?

What is the course of action when a G tube traverses the liver?

Retained G tube fragment, perform retrieval or let it pass with peristalsis?

Management of bleeding after a G tube exchange

Conclusion and/or Teaching Points:

After reviewing this exhibit, the IR trainees will be better prepared to manage, employ techniques, and avoid pitfalls encountered in enteric tube exchanges.