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Percutaneous Endoscopic Gastrojejunostomy Tube Placement: A Technique Using a Tapered Dilator within a Peel-away Sheath

Jaclyn Clark, MD, Lindsay O’Meara, CRNP, Jose J Diaz, MD. University of Maryland

In patients with gastric dysfunction who require nutritional support, jejunal feeding is a safe method for providing enteral nutrition. There are several approaches to place gastrojejunostomy (GJ) tubes, including percutaneous, open, radiologically-guided, endoscopic and various combinations of the above.  It can often be difficult to thread the GJ tube into the pylorus, so we present a percutaneous, endoscopic GJ tube placement technique using a tapered dilator within a tear-away sheath.  We combine elements from a percutaneous GJ kit as well as a percutaneous tracheostomy kit.  We perform upper endoscopy and use safe passage technique to determine candidacy for percutaneous approach.  We then fashion a tear-away sheath placed over a tapered tracheal dilator.  We place three transabdominal fasteners into the stomach under direct visualization.  An incision is made, the angiocatheter inserted into the stomach and a guide wire advanced. The tract is then serially dilated using a tracheal dilators. The dilator-sheath combination is advanced over the guidewire through the stomach into the duodenum. The dilator is removed leaving the sheath in place. The GJ tube is then inserted through the sheath and placement confirmed using fluoroscopy. The tear-away sheath is then removed and the tube secured.  This method allows for efficient and facile access to the pylorus. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95736

Program Number: V233

Presentation Session: Video Loop Day 2

Presentation Type: VideoLoop

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