Access to adequate nutrition is fundamental for health. For individuals unable to consume food safely or sufficiently by mouth, a feeding tube becomes a necessary medical intervention. These tubes deliver specialized liquid nutrition directly into the digestive tract, ensuring the body receives required calories, fluids, and medications. The gastrojejunostomy tube, commonly called a GJ tube, represents a specialized solution for patients with specific digestive tract challenges.
Defining the GJ Tube and Its Function
The GJ tube is a single, dual-lumen device providing access to two different parts of the upper gastrointestinal tract through one abdominal opening. The gastric (G-port) channel terminates in the stomach and is primarily used for decompression, or venting, to release excess air or fluid, which helps to alleviate nausea and abdominal distension. The G-port may also be used for administering certain medications or draining stomach contents.
The jejunal (J-port) channel extends through the stomach and the pylorus into the jejunum, the middle section of the small intestine. This J-port delivers the primary source of nutrition directly into the small intestine, bypassing the stomach entirely for feeding. This mechanism distinguishes the GJ tube from a standard gastrostomy (G) tube, allowing for effective feeding even when the stomach is not functioning properly.
Clinical Reasons for Use
The need for a GJ tube is determined by a patient’s inability to tolerate feeding directly into the stomach, often due to poor gastric motility or a high risk of aspiration.
One common indication is severe gastroparesis, a condition that causes impaired gastric emptying because the stomach muscles do not move food efficiently into the small intestine. Feeding into a stomach that cannot empty properly leads to discomfort, vomiting, and inadequate nutrient absorption.
Another significant reason is severe, uncontrolled gastroesophageal reflux disease (GERD) or a history of aspiration pneumonia. Aspiration occurs when stomach contents back up and are inhaled into the lungs, which can cause serious infection. By placing the feeding port past the stomach, the GJ tube significantly reduces the risk of backflow and subsequent aspiration.
Conditions like gastric outlet obstruction or anatomical changes following certain foregut surgeries may also prevent safe or effective feeding into the stomach. In these complex cases, the GJ tube offers a way to maintain gastric access for venting while simultaneously providing uninterrupted post-pyloric nutrition.
Placement and Initial Recovery
GJ tubes are most commonly placed using a minimally invasive, image-guided technique performed by an interventional radiologist, though endoscopic placement is also an option. The procedure usually takes about one hour and uses conscious sedation or general anesthesia. Imaging technologies, such as fluoroscopy and ultrasound, guide the tube through the abdominal wall, into the stomach, and correctly position the J-port tip within the jejunum.
Temporary retention sutures or T-fasteners may be used during placement to secure the stomach wall to the abdominal wall and prevent leakage. Following the procedure, the patient is monitored for several hours to manage site pain, which is typically mild and lessens quickly. An initial X-ray confirms the J-port position before feeds begin.
The J-port is often ready for use quickly, sometimes within hours or the next day, with feeds starting slowly to allow the digestive system to adjust. Patients receive detailed instructions on managing the insertion site before discharge. Retention sutures, if used, are typically removed within ten to fourteen days as the tract heals.
Daily Care and Management
Long-term management of a GJ tube focuses on maintaining skin integrity around the stoma site and preventing clogging or migration. Daily care involves gently cleaning the insertion site with mild soap and water, or a prescribed solution, to remove debris or drainage. The area must be rinsed well and dried completely to prevent skin irritation and infection.
Proper flushing is essential to prevent tube occlusion. The tube should be flushed with 30 to 60 milliliters of warm water before and after every feed and medication administration. If the G-port is not actively used, it should still be flushed at least once daily to maintain patency.
The tube must be secured to the body to prevent accidental pulling, which could lead to painful dislodgement or migration of the J-port. Caregivers should ensure the external bolster rests snugly against the skin, allowing about a dime’s width of space to prevent excessive pressure. If the tube clogs, a gentle attempt to flush with warm water is the first step, but a medical professional should be contacted if the clog cannot be cleared.