PER-ORAL IMAGE GUIDED GASTROSTOMY (PIG)

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1 PER-ORAL IMAGE GUIDED GASTROSTOMY (PIG) Information Leaflet Your Health. Our Priority.

2 Page 2 of 6 What is a Per-oral Image guided Gastrostomy (PIG)? A Per-oral image guided Gastrostomy (PIG, also PIGG or PRG) is a procedure to insert a small tube into your stomach. The procedure is carried out by Radiology doctors who use X-rays to guide the tube into the correct position. The tube will be used to give liquid food and medication. Why do I need a PIG? There may be several reasons why you may not be able to eat normally, such as a blockage in your throat, mouth or gullet or a risk of food and drink going down the wrong way into the lungs or you may have difficulty swallowing due to a neurological illness for example stroke. In order to get the nutrition that you need your doctor has recommended that you are fed directly into a tube in your stomach. A PIG feeding tube will not alter the outcome of your underlying disease or condition. Who has proposed this procedure? The doctors and the multidisciplinary team caring for you and the Radiologists have discussed your situation and feel that this is a good option for you. A doctor or nurse will discuss the procedure and talk to you about the risks and benefits of having a PIG. Please do not be afraid to ask questions about the procedure. It is important that family members have been involved in these discussions as they may be involved in helping you care for your PIG. Are there any alternatives? Sometimes feeding can be achieved by passing a naso-gastric tube; a thin tube through the nose and into the stomach, this method is generally suited to short term use. A PIG is more comfortable and easier to manage at home. A PIG is more discreet and can be hidden under your clothes. There are other alternatives and if you decide not to go ahead with the PIG, your doctor or nurses will discuss other options available to you.

3 Page 3 of 6 Risks and Complications Although the procedure is relatively safe and major complications are rare, there are risks involved as with any medical procedure. Should there be any major complications it may be necessary to carry out an operation The major complication rate of this procedure is 6% this includes Bleeding Bowel perforation Inflammation / infection in the abdomen Minor complications include leakage / infection around the tube resulting in red and sore skin. Post procedure pain is not uncommon but should be manageable with simple pain killers. Please inform the nurse looking after you if it s not settling. How do I prepare for the procedure? You will be asked to sign a consent form to show that you have had a discussion with your medical team. If you are unable to consent to the procedure, discussion will take place with your family by the medical team looking after you. You will be an inpatient in hospital and will not be allowed to eat or drink for up to 6 hours before the procedure. You will be asked to change into a hospital gown and a cannula will be inserted into your arm so that we can give you pain relief, antibiotics and possibly sedation to make you feel relaxed and sleepy. If you do not already have one, a naso-gastric tube will be passed through your nose and into your stomach. This is used to introduce air into your stomach during the procedure to make it more visible on x-ray. The day before the procedure you will be given a milky drink to outline the bowel during the procedure to ensure the tube is correctly sited. If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium, the dye used for kidney x-rays and CT scanning, you must also tell your doctor about this. Please let us know if you take any medications that thin your blood, as these may need to be stopped before the procedure.

4 Page 4 of 6 What will happen during the procedure? The PIG will be inserted in the x-ray department by a specially trained doctor called a Radiologist. Once in the X-ray department you will be asked again if you fully understand the procedure. You will be asked to lie on the X-ray table, on your back. The nurses will attach a blood pressure cuff to your arm and monitor your vital signs during the procedure. The nurse will give you some oxygen during the procedure. The Radiology nurses will spray the back of your throat with a local anaesthetic spray. And then place a small mouth piece in your mouth. You will also be given an antibiotic, some sedation and pain relief through a needle in your arm. Once you are sedated the Radiologist will pass a special wire, called a snare, into your mouth down into your stomach. When this is in place the Radiologist will paint the skin around your stomach with antiseptic and drape your skin with sterile towels before injecting your skin with local anaesthetic. This may sting for a short while until the skin goes numb. Air will then be pushed into your stomach through the naso-gastric tube to help position the tube. The doctors will then place a needle into your stomach followed by a small guide wire, which will be pulled out through your mouth using the snare. The gastrostomy tube will be placed over the wire and into your stomach and out through the skin. Once in place you will return to the ward. The procedure may take minutes What happens after the procedure? The nurses on the ward will monitor your recovery. You will be advised to rest in bed for a few hours following the procedure. When the tube is first placed, you may feel some discomfort around the area. This generally settles and pain relievers can be given. In most cases feed and medicines can be given through the PIG after about 4 hours. The naso-gastric tube can be removed once the PIG is inserted and working properly. How long will the tube stay in? Over the next few days you and your family will be shown how to care for your PIG tube. The tube is designed to stay in for a long term. Depending on your condition it can be used continuously or intermittently. If it is no longer required it can be removed without the need for any further operations.

5 Page 5 of 6 Problem with the tube? If you have a problem with your tube please contact your General Practitioner. In an emergency e.g. your tube falls out, please attend your local Emergency Department. Contact us Interventional Radiology Department of Radiology, X-Ray B

6 Page 6 of 6 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Information Leaflet. PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number RAD96 Publication date March 2014 Review date March 2016 Department Interventional Radiology, X-Ray B Location Stepping Hill Hospital