Gastrostomy

Your doctor has requested that you have a gastrostomy - sometimes referred to as a RIG (radiologically inserted gastrostomy) or PIGG (per-oral image guided gastrostomy). We hope the following information will answer some of the questions you may have about this procedure.

What is a gastrostomy?

A narrow plastic tube is placed through the skin into your stomach. Once in place, the tube can be used to give you liquid food directly into your stomach to provide nutrition. Gastrostomies are placed by specially trained doctors called interventional radiologists. 

Why do I need to have a gastrostomy?

You may be unable to eat or drink sufficient amounts to satisfy your nutritional needs or there may be a problem with swallowing that makes it unsafe for you to eat or drink. 
You may have had a small plastic tube inserted through your nose, down into your stomach, to help with your feeding. This can only be left in place for a relatively short period of time.

What are the risks associated with a gastrostomy?

A gastrostomy is a very safe procedure however there are a few risks:

  • Occasionally, it is not possible to place the tube into your stomach. This may require a different method of placement or occasionally you may need an operation to place the tube.
  • Sometimes there is a leak around the tube. This can lead to the skin around the tube becoming very red, sore and painful (localised peritonitis).  It may become necessary to remove the tube to allow healing to occur or an operation may be needed to sew up the hole in your stomach.
  • Very rarely, a blood vessel can be punctured when passing the needle into the stomach. This can result in bleeding. This usually stops by itself, but if not, you may need a blood transfusion. Occasionally it may require another procedure to block the bleeding artery or an operation to stop the bleeding. However, this is extremely rare.
  • Infection is a rare complication.  If the skin around the tube becomes hot or inflamed or you have a temperature after tube insertion you may need a course of antibiotics.  
  • The procedure uses x-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging department before attending the appointment.

What happens before the procedure?

You will need to have a blood test a few days before the procedure to check that you are not at an increased risk of bleeding.  This may be arranged to take place at your GP surgery.  

If you are taking any blood thinning tablets (e.g. aspirin, clopidogrel, warfarin, dabigatran, rivaroxaban or apixaban) please contact the Imaging department before the appointment. These may need to be stopped to keep the risk of bleeding to a minimum. 

Usually you will be admitted to hospital before the procedure and you will stay for a few days following it so that feeding can be established before you go home.

On the day of the procedure

You should not eat anything for 6 hours before your appointment. You may drink water until the time of your appointment. 

You may take your normal medication unless instructed otherwise. Please inform us if you are allergic to anything.

You will be transferred to the Imaging Department (Gate 19) and be accompanied into our day case area.

You will be asked to change into a hospital gown and a cannula (a small tube) will be placed in a vein in your arm for pain relief if needed.

The interventional radiologist will discuss the procedure with you. You will have an opportunity to ask questions about the procedure and your treatment. 

If you choose to have the procedure you will need to sign a consent form. 

What happens during the procedure?

Once all the checks have been performed and a consent form signed, you will be taken to the angiography suite (x-ray room) on the trolley. There will be a radiologist, nurses and a radiographer with you throughout the procedure.

You will be asked to lie on your back on the x-ray table. You will have monitoring devices attached to your chest and finger so that we can monitor you throughout the procedure.  

Using an ultrasound machine, the radiologist will scan your abdomen to help visualise the stomach, liver and bowel.

If you do not already have one inserted, a small tube will be placed through your nose into your stomach (NG tube). This is so that we can inflate the stomach slightly with air for the procedure.

An area of skin on your abdomen will be cleaned with an antiseptic solution and covered with sterile drapes. 

The radiologist will then inject local anaesthetic into the area where the gastrostomy tube will be inserted, which will briefly sting and then go numb. Most people feel a pushing sensation after this. 

A small needle is placed into the stomach wall through which a very fine wire is passed through. A catheter (very fine tube) is then navigated up the oesophagus (gullet or food pipe) and will come out of your mouth. This then allows the gastrostomy tube to be pulled down into your stomach and out through the abdominal wall.

What happens after the procedure?

You will be taken back to the day case area, so that nursing staff may monitor you closely.

If you are in pain tell the nursing staff so you can be given appropriate painkillers.

Once you are feeling ok, you will be brought back to the ward where you will stay so that feeding can be established. You will see a dietician during this stay and follow-up care will be arranged for you at home.

Once you go home, if you have any discomfort take your usual pain relief, as prescribed, but if the pain is severe please contact the Imaging department on the phone number on your appointment letter.

Will this procedure be painful?

When the local anaesthetic is injected, it will sting for a short while, but this soon wears off. There may be a little discomfort during the procedure, but any pain that you have will be controlled with painkillers. You may be aware of the tubes being passed into your stomach, but this should just be a feeling of pressure and not of pain.

Finally we hope this information is helpful. 
If you have any questions either before or after the procedure the staff in the Imaging department will be happy to answer them. The phone number is on your appointment letter.

References

British Society of Interventional Radiology (2011) “Radiological inserted gastrostomy (RIG)”

How to contact us:

Gate 19 - Brunel building
Southmead Hospital
Westbury-on-Trym
Bristol
BS10 5NB

Please see the number on your appointment letter

www.nbt.nhs.uk/

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published January 2020. Review due January 2022. NBT003250

Gastrostomy