Gastrojejunostomy tube (GJ tube)

A gastrojejunostomy tube, or GJ tube, looks like a G tube from the outside. It passes through the belly wall into the stomach and is held by a water-filled balloon. The difference is a long, thin extension that continues out of the stomach, through the first part of the small intestine (the duodenum), and ends in the next part, called the jejunum.

The tube has separate ports. The J port delivers formula into the intestine. The G port opens into the stomach and is used to let out gas and fluid, called venting, and sometimes for medicines. A third small port fills the balloon. Each port is labeled.

On X-ray, the tube looks like a thin white line that loops through the stomach, curves around the C-shaped duodenum and ends past a landmark called the ligament of Treitz, in the upper small intestine.

GJ tubes can also be placed by a gastroenterologist with an endoscope, often called a PEG-J, or by a surgeon. If you already have a G tube with a healed tract, we can often convert it to a GJ tube in a short procedure through the same opening.

The procedure is done at El Camino Hospital with two nurses, a technologist and your interventional radiologist. Your heart rate, blood pressure and oxygen are watched throughout.

1. 1
   Relaxing and preparing

   Moderate sedation through your IV helps you relax. A thin tube is passed through your nose into your stomach, and the stomach is gently filled with air.

2. 2
   Anchoring the stomach

   After numbing the skin, we place 2 to 4 small anchors called T-fasteners to hold the stomach against the belly wall.

3. 3
   Entering the stomach

   A needle and guidewire enter the stomach between the anchors. The opening is gently widened.

4. 4
   Guiding the tube into the intestine

   Using X-ray, we steer a wire out of the stomach and around the duodenum into the jejunum. The GJ tube follows the wire, and the balloon is filled in the stomach.

5. 5
   Checking and finishing

   Contrast dye confirms the tip position. The outer disc is snugged to the skin and the nose tube is removed. The procedure itself takes about 30 minutes.

1. First hour
   You recover while the nurses check your site and vital signs. Family can join you.
2. Same day
   The J port can usually be used for feeding right away, starting slowly. No driving if you had sedation.
3. Next day
   You may shower. Pat the site dry afterward.
4. First week
   Soreness fades over 2 to 3 days. Avoid heavy lifting and strenuous activity.
5. 1 to 4 weeks
   The T-fasteners fall off on their own. Throw them away.

Clean the skin daily with soap and water, and keep it dry. Check that the outer disc is snug. Do not rotate a GJ tube the way you might rotate a G tube, because twisting can move the J extension.

When someone keeps vomiting their tube feeds, I often recommend moving the feeding tip past the stomach. The GJ tube lets us feed the intestine and vent the stomach at the same time. I tell families that GJ tubes need a little more attention than a simple G tube, and that if feeds suddenly start coming back up, the J part may have slipped back into the stomach. That is a quick fix in the X-ray room.

Fabio Komlos, MD, interventional radiologist · About Dr. Fabio Komlos