Date issued: November 2019
For review: November 2021
Ref: B-248/Imaging/RA/Radiological (RIG) v3
This leaflet tells you about having a radiological inserted gastrostomy (RIG). It explains what is involved and what the possible risks are. It is not meant to replace informed discussion between you and your doctor, but can act as a starting point for such discussions. If you have any questions about the procedure please ask the doctor who has referred you or the department which is going to perform it.
The referring clinician should have discussed the reasons for this examination with you in the clinic and you should make sure that you understand these before attending. You will be referred to a radiologist for this procedure. Radiologists are doctors who have trained and specialised in imaging and x-ray treatments.
Before the procedure you will need to sign a consent form. This form says that you need to know what risks are involved. This is a legal requirement and ensures that you are fully informed about your procedure.
If after discussion with your hospital doctor or radiologist you do not want this examination then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary then he/she will explain this to you and communicate with the referring clinician. You will return to your referring clinician for review.
At all times the radiologist and referring clinician will be
acting in your best interests.
What is a gastrostomy?
Gastrostomy is a technique where a narrow plastic tube is placed 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. Gastrostomy tubes can be placed endoscopically, through the mouth (PEG) or percutaneously, through the skin (RIG). RIGs are placed by specially trained doctors called interventional radiologists.
Why do you need a gastrostomy?
You may be unable to eat or drink sufficient amounts to satisfy your nutritional needs or there may be a problem with swallowing that makes it unsafe for you to eat or drink. There are several reasons for this.
You may have had a small plastic 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. Obviously, if you do not receive enough nutrition, you will become very ill.
Are there any risks?
RIG is a safe procedure, but as with any medical procedure there are some risks and complications that can arise.
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.
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. This can lead to the skin around the tube becoming very red, sore and painful (localised peritonitis). An attempt will be made to treat this but it may become necessary to remove the tube to allow healing to occur or an operation may be needed to sew up the hole in your stomach.
Very rarely, a blood vessel can be punctured accidentally when passing the needle into the stomach. This can result in bleeding. This may stop by itself, or if not, you may need a blood transfusion. Occasionally it may require another procedure to block the bleeding artery or an operation to stop the bleeding. However, this is extremely rare.
Are you required to make any special preparations?
A RIG is usually carried out as a day case procedure under local anaesthetic and mild sedation. You will be asked not to eat or drink for six hours before the procedure.
If you have any allergies or have previously had a reaction to the dye (contrast agent), you must tell the radiology staff before you have the test.
If you are pregnant or suspect that you may be pregnant you should notify the department. A baby in the womb may be more sensitive to radiation than an adult. There is no problem with something like an x-ray of the hand or chest because the radiation field is at a safe distance from the foetus. However, special precautions are required for examinations where the womb is in, or near, the beam of radiation. If you are a female of childbearing age the radiographer will ask you if there is any chance of you being pregnant before the examination begins and you will be asked to sign a form. If there is a possibility of pregnancy then your case will be discussed with the team looking after you to decide whether or not to recommend postponing the investigation.
There will be occasions when diagnosing and treating your illness is essential for your health and where the benefit clearly outweighs the small radiation risks. The procedure may go ahead after discussing all the options with you.
Who will you see?
A specially trained team led by an interventional radiologist within the radiology department. Interventional radiologists have special expertise in reading the images and using imaging to guide catheters and wires to aid diagnosis and treatment.
Where will the procedure take place?
In the interventional radiology suite which is located within the radiology department. This is similar to an operating theatre into which specialised X-ray equipment has been installed.
What happens during an gastrostomy?
You will be asked to get undressed and put on a hospital gown. A small cannula (thin tube) will be placed into a vein in your arm. Antibiotics, sedation, and pain killers will be given. Medications to slow down the stomach movement may also given. You will lie flat on your back. You may have monitoring devices attached to your chest and finger and may be given oxygen. If you do not already have one inserted, a small tube will be placed through your nose into your stomach. The procedure is performed under sterile conditions and the interventional radiologist will wear a sterile gown and gloves to carry out the procedure.
The skin below your ribs will be swabbed with antiseptic and you will be covered with sterile drapes. The interventional radiologist will use an ultrasound probe and X-rays once your stomach is filled with air to decide the best site for the RIG. Local anaesthetic will be injected into the skin to numb the area and you will probably be given sedation.
A small needle is placed into the stomach through which a special feeding tube is placed. There are many different types of feeding tube available – some initially need stitches to keep them in place, others do not. Your interventional radiologist will discuss this with you.
Once the RIG is in place, the tube in your nose will be removed.
Will it hurt?
When the local anaesthetic is injected, it will sting for a short while, but this soon wears off. There may be a little discomfort during the procedure, but any pain that you have will be controlled with painkillers. You may be aware of the tubes being passed into your stomach, but this should just be a feeling of pressure and not of pain.
How long will it take?
Every patient is different, and it is not always easy to predict; however, expect to be in the radiology department for about an hour.
What happens afterwards?
You will be taken back to your ward. Nursing staff will carry out routine observations including pulse and blood pressure and will also check the treatment site.
You will stay in bed for four hours by which time the RIG can generally be used. A specialised interventional radiology nurse will visit you on the ward before discharge with an information pack.
Your stomach may feel a little sore for a few days. If necessary, this can be controlled with painkillers.
How long will the tube stay in?
This is a question that can only be answered by the doctors looking after you. It all depends on why you need the tube in the first place. You will need to discuss this with your consultant. The tube needs to stay in place until you can eat and drink safely and normally. In some cases, this might not be for a very long time.
You will have a specially trained dietitian looking after you who will show you how to look after the tube properly. If your tube has stitches holding it in place, they will automatically fall out within 21 days. If they have not fallen out by this time then they can be removed by the community team. The tube is kept in place by a balloon and the nurse or dietician caring for you will show you how to care for this.
Gastrostomy insertion is a safe procedure but as with any procedure or operation complications are possible. We have included the most common risks and complications in this leaflet.
We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation.
Any exposure to ionising radiation (e.g. X-rays) has the potential to cause cancer later in life. This is much lower than the risk we all have of developing cancer in our life of ~1 in 3 and will be considered by the doctor before your procedure.
For information about the effects of X-rays read the publication:
“X-rays how safe are they” on the Health Protection Agency website: www.hpa.org.uk
ome of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Interventional Radiology Department