This is a relatively simple procedure which can be performed by IRs of all skill levels and for patients of
all age. The external component of the GJ is examined for any issues that might hamper the exchange,
such as a neck fracture. Then, a guidewire is inserted into the GJ tube’s jejunal lumen until the wire
extrudes through the jejunal limb. Once the wire is properly advanced, the balloon of the prior tube is
deflated. The tube is removed over the guidewire. The stoma can be measured, if necessary, with a
dedicated stomal measurement device. Then, the appropriate tube is selected and advanced over the
guidewire. The balloon is inflated. Contrast media is injected via the gastric and jejunal lumens to
confirm adequate position of the tube and balloon, and ensure that there is antegrade flow from the
jejunal limb. Additionally, tension on the small intestine from the catheter tip should be carefully examined for risk of perforation of the bowel.

Bowel perforation.