64 year old male patient who presents with dysphagia after a stroke. He requires enteral support and undergoes gastrostomy tube placement.
These images represent the procedural technique involved with gastrostomy tube placement. Initially, the stomach is inflated with air to facilitate placement of Cope anchors. These are designed to affix the stomach to the anterior abdominal wall. Note that once the stomach is distended with air, three anchors are placed. At that point, a single wall needle is used to access the air-filled stomach in the middle of the 3 anchors. Once the needle is in place, a guidewire is coiled within the stomach. Serial dilatation is performed to accommodate an appropriately-sized peel-away sheath. An “appropriately-sized” peel-away sheath typically means one that is 4 sizes larger than the feeding tube being placed (20F sheath for a 16F tube). Once the tube is in place, the sheath is removed, and the balloon on the gastrostomy tube is inflated with sterile water with a small amount of contrast for opacification. The balloon is pulled back against the anterior wall of the stomach and affixed with the skin. We typically wait 24 hours for feeding to make sure that the patient is tolerating the tube well without signs of peritonitis.