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Continuous pain after ENDOSCOPIC G-J STENT REPLACEMENT.

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I am a 26 year old female, now 5 days removed from an endoscopic g-j tube replacement (Mickey Button). I am experiencing continuous pain that increases significantly with administration of tube feeds, (even at very low feed rates 10ml/hour). This is the fourth time I have had my g-J tube replaced. Each time with a mickey button. The initial placement and subsequent replacements were done by interventional radiology. I never had any problems increasing feed rate or tolerating continuous feeding after these tube replacements. Feedings have always been relatively painless until now. I have my G-J tube because I have non-diabetic gastroparesis that often prevents me from taking food or fluids by mouth.

Inexplicably, this time the placing hospital informed me the tube would be placed via endoscopy. While previous tube replacements by IR have taken less than an hour, this last tube replacement via endoscopy took almost 4 hours. I spoke to the surgeon that placed this tube and asked why the procedure took this long. He responded that they anchored the jejunal extension of the tube with an endoclip, and that they "had trouble clipping it."

It has now been 5 days since the initial tube replacement and endoclip placement via endoscopy and I am experiencing lower abdominal pain that increases in proportion to the time feeding lasts and the rate of feeding. I have only been able to tolerate up to 10/ml per hour for 1 hour before stopping and I am left in severe pain. I am on IV Dilaudid 2q3. Clearly, this feed rate is not sufficient to provide anywhere near the nutrients I need. The doctors have verified tube placement via x ray, and do not see any abnormalities in my blood work. I suspect their working theory is that my pain is psychogenic, but they do not communicate with me very well. Their refrain has been that the tube is physically intact and that I will be fine if I taper up my feeding rate and duration. I am of sound mind and I am positive the pain I am experiencing is because something is physically different, not because my mental state has changed (it hasn't). I am unable to tolerate the pain that increased feeding rates and duration causes, so I am starting to get desperate.
My question is this: I have never experienced difficulty tolerating feed due to pain with previous tubes. All of these tubes were replaced via interventional radiology and nothing is different about the circumstances and events surrounding this replacement. So far as I can see, the only difference with this latest tube is that it was placed endoscopically and is anchored with an endoclip. Is there any way the placement method or the inclusion of an endoclip could explain the pain I am experiencing?

Category: Gastroenterologist, Surgical

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Category: Gastroenterologist, Surgical
 27 Doctors Online

Hello,
Thank you for your query at DoctorSpring.com
There should be no difference with the type of tube placement
Endoscopic and radiologically they will place the tube into jejunum only
Pain may be because of some hematoma at site of endoclip application site or endoclip might be placed slightly deep in to the intestine or tube might have been placed far into small intestine
I hope this pain should subside in another 1 week once hematoma or edema subside

Thank you
Dr. Lokesh


Patient replied :

Thank you for your prompt response.
I understand that hematoma or edema caused by the attachment of the endoclip to the intestinal wall could explain the pain. The pain I experience increases gradually with feed duration and becomes unbearable after approximately one hour. I have had multiple surgeries in my life, so I know pain, but this pain is quite severe.
My follow up question is:
Why then would pain increase while tube feedings are being administered? And could the endoclip placement actually have caused hematoma or edema substantial enough to explain pain this serious?(It is severe enough that I am forced to stop the flow of feed).


Sorry for delay in replying
Yeah hematoma can cause pain after starting feed as there will be increased peristaltic movements.
As u have mentioned ur surgeon had difficulty in applying Endoclip...i think that should explain the pain
Other than these reasons few rare causes are if tube is not in place or if there is some small leak of feed into peritoneal cavity or if there is intussusception of jejunum at the site of Endoclip application
To confirm better to go for CT scan abdomen just after taking a feed to look for the cause of pain
Regards.


Dr. Lokesh HM
Category: Gastroenterologist, Surgical
Experience: 
Fellowship: Minimal Access Surgery (FMAS)
Fellowship: Pancreato-Biliary surgery (FPBS), SGPGI Lucknow, 2012
Senior Residency: MCh, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI) Lucknow, 2011
Junior Residency: MS, PGIMER, Chandigarh, 2008
Medical School: MBBS, MS from Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh, 2007
Dr. Lokesh HM and 4 other Medical Specialists are ready to help you

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