GJ-tubes are placed in the stomach just like G-tubes, but a thin, long tube is threaded into the jejunal (J) portion of the small intestine. GJ-tubes can be a great aid for individuals with dysmotility, those who aspirate, and those who are losing a great deal of calories due to vomiting, but are not good candidates for a fundoplication. Rather than feeding into the stomach like G-tubes, GJ-tubes can be used to bypass the stomach and feed directly into the second portion of the small intestine. The gastric port can be used to give medications, vent air, drain fluids, and give feeds if appropriate and safe for the individual.
The vast majority of children who get GJ feeding tubes begin with G-tubes; it is rare for a GJ-tube to be placed initially. Most GJ-tubes have separate ports to access both the stomach (G-port) and the small intestine (J-port), though some tubes, often called Transjejunal (TJ) tubes, only allow access to the small intestine. GJ-tubes are available both as buttons or long tubes.
Switching from a G-tube to a GJ-tube is a relatively simple procedure. If there is already a G-tube in place, the GJ-tube can be placed into the same stoma, so no additional surgery is required. The switch is done in the Interventional Radiology department. A special kind of continuous X-ray called fluoroscopy is used to correctly place the GJ. Some hospitals allow parents to be in the room and others do not.
Also, sedation is used by some facilities, but others do not use any type of sedation. While the procedure is not usually very painful, it can be uncomfortable, and some children have trouble staying still or experience anxiety during the procedure. Initial placement can be more difficult than subsequent GJ-tube changes. In subsequent replacements, a guide wire can be threaded through the tube that is already in place so that the new tube can easily be put into the correct position.
Switching from a G-tube to a GJ-tube may not necessarily stop a child from refluxing or vomiting. What it can do is prevent the loss of calories from vomiting by allowing the formula to bypass the stomach so that it cannot be vomited up.
One of the challenges of a GJ-tube is that the J portion holds the pylorus partially open, and that means that bile from the small intestine can potentially seep into the stomach. This can be problematic for an individual with chronic vomiting, severe reflux, or aspiration of reflux. Having a GJ-tube is a godsend for a child who has any of these problems because the stomach can be vented without interrupting feeds. If bile reflux is a problem, the stomach can be vented continuously to prevent the bile from being vomited or refluxed and aspirated. Some doctors prefer for the bile to be re-fed through the J-port, but others prefer to replace it with an equal volume of Pedialyte. It may depend on the amount of drainage, the patient’s condition and tolerance. Other times, IV fluids are the best option for rehydration and replacement of lost electrolytes.