Gastrointestinal Services

At the Metropolitan Vascular Institute, we are equipped to manage many of your GI diseases and GI related symptoms. We can place long-term feeding tubes, help alleviate pain and discomfort from liver or gallbladder obstruction, and manage the removal of ascites (fluid in the belly).


Paracentesis is a procedure in which fluid from the abdomen is removed through a needle. There are two reasons to take fluid out of the abdomen; one is to analyze it, the other is to relieve pressure. The liquid that accumulates in the abdomen is called ascites. Ascites seeps out of organs for several reasons related either to disease in the organ or changing fluid pressures. This procedure is performed using local anesthesia and ultrasound guidance. In some cases this procedure may be repeated, sometimes even weekly, to provide the patient with relief from their discomfort.

Tunneled Peritoneal Catheter Placement/Removal

tunnelled peritonial
Tunneled Peritoneal Catheter

Tunneled peritoneal catheter insertion is performed as a treatment option for recurrent ascites (fluid in the abdomen). Patients with metastatic cancers or liver disease are typically candidates for this procedure. Patients with ascites due to cancer are able to have a tunneled peritoneal catheter placed to relieve their abdomen fullness, pain, and breathing issues. This procedure is performed using conscious sedation, ultrasound and x-ray guidance. The patient can connect the tunneled catheter to disposable drainage bottles, at home. This eliminates repeated office visits to have their fluid drained.

Percutaneous Gastrostomy Tube Placement/Changes

A gastrostomy is a direct opening from your abdominal wall into your stomach through which you can be fed. This procedure is performed when you cannot swallow, either because you have had a stroke, or you have developed another problem that makes it hard for you to swallow. Most of the time gastrostomy is a temporary measure, but sometimes it is permanent.

Percutaneous Gastrostomy Tube

The procedure is performed using conscious sedation. Air is placed into the stomach so that it can be easily accessed percutaneously (through the skin) and better visualized under fluoroscopy. In order to achieve this, we will place a small catheter through the nose and into the stomach by passing it down the esophagus. Once the stomach is “inflated”, access is gained with a needle and a guide wire. This access is converted into a feeding tube. Exchanging a gastrostomy tube is easily done using a guide wire. A tube may need to be exchanged if it becomes clogged or if it breaks.

Cholecystostomy Tube Placement/Changes

A cholecystostomy is a procedure where a stoma is created in the gallbladder, which can facilitate placement of a tube for drainage. It is sometimes used in cases of cholecystitis, where the patient is critically ill, or if there is a need to delay cholecystectomy (surgical removal of the gallbladder). After the patient’s symptoms resolve and his/her condition is stabilized, definitive treatment is still gallbladder removal.

Cholecystostomy Tube Placement/Changes

This procedure is performed using conscious sedation. The drainage catheter is placed once access to the gallbladder is achieved with a needle and guide wire. Access is easily accomplished using ultrasound and x-ray guidance.

Exchanges of these drainage catheters may be necessary if they become clogged and stop draining. This is a quick, straightforward procedure, and can be done using a guide wire.

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