FINDINGS: The risks, benefits, and alternatives were extensively discussed
with the patient. Patient elects to proceed and written and verbal consent
was obtained. Extensive discussion was performed with the patient
related to pain, infection, bleeding, local anatomical injury, effects of
contrast on renal function, myocardial infarction, stroke, and death.
Consent was obtained for all the above to include off label use of devices.
Time-out was obtained. Maximum barrier technique was used including caps,
masks, sterile gowns, sterile gloves, a large sterile sheet, hand hygiene,
and 2% chlorhexidine percutaneous antisepsis.
With the patient in a right decubitus position, a scout radiograph was
obtained. Through the existing catheter after sterile prep and drape, a 5
French Berenstein catheter and stiff angled glide wire were used in attempt
to recanalize the tract. Dilute contrast was injected not clearly
demonstrating the tract. With the catheter and wire positioned near the
abdominal wall musculature, where eventually was used to recanalize the
tract into the lumen of the stomach. Dilute contrast was injected to
confirm the appropriate positioning within the lumen of the stomach. The
wire was exchanged for an Amplatz wire. A 12 French Boston
Scientific/MediTech locking all-purpose drainage catheter was advanced into
the stomach to help support the tortuous tract with the metal cannula. An
Amplatz wire was advanced over a catheter to the antrum of the stomach.
Multiple attempts to advance a new cast jejunostomy tube 16 French failed.
Subsequently, tract dilatation with a 7 mm x 40 mm mustang balloon was
performed throughout the entire length of the tract. Through the
gastrojejunostomy that was trimmed shorter multiple times, eventually using
a long 7 French destination sheath with its introducer inside the
gastrojejunostomy tube, were able to advance it in the stomach. Ultimately,
the native gastrojejunostomy 16 French catheter was trimmed 20 cm shorter
with the distal 5 cm custom side holes added. The balloon was inflated with
10 mL of sterile water. The catheter was retracted to the anterior gastric
wall with the disc placed flushed with the skin. Dilute contrast was
injected through the catheter demonstrating appropriate position within the
1. Successful replacement with a modified 16 French gastrojejunostomy tube
from 20 cm shorter with new 5 cm of custom sidehole at the distal aspect.
The balloon is inflated with 10 mL of sterile water, which will hopefully
prevent dislodgment. Although the infusion will occur always from the
abdominal wall with this modified technique. With the stomach is
decompressing, the tip of the catheter will hopefully migrate towards the
antrum of the stomach.
2. The catheter may be used immediately.