Indications

• Long-term nutritional support

• Gastric decompression

• GJ: Aspiration, reflux, gastroparesis

Contraindications

• Absolute:

  • • Lack of safe access into the stomach

    • Uncorrectable coagulopathy

• Relative:

  • • Previous gastric surgery

    • Gastric cancer or varices

    • Uncorrected ascites (must be drained)

Imaging Review

• Obtain abdominal CT if hx of gastroesophageal surgery, varices, or peritoneal disease.

• Otherwise, cross-sectional imaging is not mandatory. Review priors for:

  • • Safe access into stomach? Colon in the way?

    • Ascites, abscesses, or other anatomy that should not be traversed.

• Determine if pt is candidate for Barium (see consult note template) and order for KUB morning of the procedure to show opacified colon.

Tips for Workup

• Many of these pts will have airway or mental status issues that preclude moderate sedation. Evaluate whether pt is good candidate for single agent (IV fentanyl or versed) vs anesthesia.

• Note that the tube must stay to drain and cannot be used for feeds in the first 24 hours (some institutions say 12 hours or even less).

• Tube must remain in place at least 6 weeks before it can be removed or exchanged to allow the tract to epithelialize and prevent peritonitis.

• Ask the pt whether they might prefer a low-profile tube (MIC-Key, GJet, etc), which can be exchanged for the standard tube at 6 weeks or any time after.

• Consent: Hemorrhage, infection, peritonitis, bowel injury/perforation, pneumoperitoneum (small amt is normal), pyloric obstruction.