Radiologically Inserted Gastrostomy (RIG) in Cyprus
Gastrostomy is a procedure in which Dr Zertalis uses ultrasound (US) and X-Rays (Fluoroscopy) to insert a narrow plastic tube 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.
Benefits
Gastrostomy provides an alternative route of nutrition in patients who are:
- Unable to eat or drink sufficient amounts in order to meet their nutritional needs
- Having problems and difficulties with swallowing
- Due to have surgery and/or radiotherapy which may compromise their ability to feed via the oral route either temporarily or permanently.
You may have had a small plastic tube (nasogastric 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. An alternative long-term route for nutritional support such as a radiologically inserted gastrostomy (RIG) is essential to preserve life.
Risks
RIG is a safe, effective and accurate procedure, but as with any medical procedure there are some risks and complications that you may uncommonly experience.
Bleeding: Significant bleeding requiring treatment is rare (0.1%) and on very rare occasions, this may require another interventional radiological procedure or surgery to stop it.
Infection: This is an uncommon complication. You will be given antibiotics before the procedure and you will be monitored during and after the procedure to check for signs of infection.
Failure: 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.
Leak: Sometimes there is a leak around the tube. This is less likely to happen if the stomach has been attached to the muscles beneath the skin, but it can still sometimes occur.
Damage to bowel: This is uncommon and can occur while attempting to navigate needles into the stomach.
Allergy to contrast (X-ray dye): Most adverse events are mild and can be managed safely in our department. A major life-threatening contrast reaction is rare (< 0.005%).
Kidney Impairment: Impairment of kidney function can occur following the treatment due to the contrast agent or dehydration. You will have a drip placed before the procedure. This is to give you sufficient fluids to minimise the risk of problems with kidney function.
Radiation Risk: Immediate harmful effects such as skin burns, or radiation sickness are extremely rare. The radiation dose you receive during the procedure is monitored to prevent this. On rare occasions the procedure will have to be stopped if the threshold for immediate harmful effects is reached. Increase in lifetime risk of cancer due to radiation per examination is also rare (< 0.001%).
Dr Zertalis will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
Before the procedure
The procedure is performed with local anaesthetic and sedation. You will be asked not to eat or drink for 6 hours before the procedure. Relevant bloods test will be undertaken and a short thin plastic tube (cannula) will be placed into a vein in your arm.
Please let Dr Zertalis know about any medications you take, any allergies you may have and if you previously have had a reaction to the X-ray dye (contrast).
The procedure
You will be asked to change into a hospital gown and lie on your back. You will have devices attached to your chest, arm and finger to monitor you pulse, blood pressure and oxygen levels. You will be given a sedative to relieve anxiety and painkillers where necessary. This is standard for all minimally invasive interventional radiology procedures performed in Cyprus.
The procedure is performed under sterile conditions and Dr Zertalis will wear sterile gowns and gloves to carry out the procedure. The skin near the point of insertion will be swabbed with antiseptic and you will be covered with sterile drapes.
Your skin near the point of insertion will be numbed using local anaesthetic. When the local anaesthetic is injected you will likely experience a burning sensation for 30 to 60 seconds. Dr Zertalis will use ultrasound (US) and X-Rays (fluoroscopy), to place a fine needle accurately into the stomach through which a special feeding tube is inserted. There are many different types of gastrostomy tubes available and Dr Zertalis will discuss this with you in detail.
Every patient is different, however, expect to be in the radiology department for up to 1 hour.
After the procedure
You will be transferred to your ward where your pulse, blood pressure, oxygen levels and the entry site in the skin will be checked by our team at regular intervals. You should expect to be in bed for 6 hours and to stay in hospital for up to 24 hours. The tube in your nose will be removed and the gastrostomy can be used after a few hours.
With regards to how long the tube will stay in, it all depends on why you need the tube in the first place. You will need to discuss this with Dr Zertalis.
