AMT Mini One Capsule exchange (with endoscopic photos)

 

A year ago I got my first AMT MiniOne Capsule.  It was an improvement from balloon buttons I’d had in the past.

I chose the AMT MiniOne Capsule, because it was a MiniOne.   I liked the MiniOne (balloon type) so much better than the more widely known, and frequently used MIC-KEY for many reasons.  The AMT MiniOne is lighter and smaller than the MIC-KEY.  The balloon  and anti-reflux valve typically last longer too.

When I got my first AMT Capsule (non-balloon), it was after a good bit of dogged determination to be able to have it.  The hospital my  gastroenterologist practiced at, had to special order it.  My doctor watched the videos before I got there for my appointment, and on the day of the exchange, there were a good many “extras” in the procedure room looking on to see exactly how this capsule thing worked.   All in all, things went smoothly though.

This previous October I knew I should be thinking about exchanging my tube for a new one.  Eight months had passed, and, as luck would have it,  my doctor had retired from doing g-tubes. He’d told me he wasn’t doing them anymore back when he switched out my last one, but somehow I figured he still do it for me.  But no.  He really had retired from all g-tube placements, and I had to find a new doctor.  That took a while.

The first thing I discovered is that it’s kind of hard to find a doctor willing to take over the care of a patient who has a tube placed by someone else.   But, I got in relatively soon to a new practice.  It is part of the  health system who handles my anyway, so it made sense to go to them for this too.

Before beginning my search for a doctor. I’d spoken to Applied Medical Technologies, and the person I talked to assured me that this institution had purchased this exact type of feeding tube from them in the past.  Well,…maybe so—but not anyone who had contact with me.  The doctors I saw for my initial consult had not heard of it.  It took months to get it in as a special order for me.  Then it took two more months to get me on the schedule for the exchange.  As it turned out, the new doctor I’d seen that one time was not going to be in town at the time they could work me into the schedule at the hospital, so another doctor (that I had not met) was going to do it.

I received all kinds of paperwork in the mail about  my upcoming  procedure.  All of it stressed how important it was that I should not to be late, or I’d have to be rescheduled.  Then, the day prior, Scheduling calls me to confirm, and it’s a different time!  Really?  But, we got that straightened out, and I got to the hospital in the correct place, at the correct time, on the correct date.

But…

They couldn’t find my device.  It was a special order (of course) and the person in charge of these things was out sick.  Contractually they could not call her at home when she was on a sick call.  The staff kept looking for it, but no one could find it.  Hours passed. I  was all prepped but with nowhere to go!  No big date for me (almost).

After a seeming eternity of hanging out at the hospital, the head nurse found it.  She had eventually called Applied Medical Technologies to ask them what the box looked like.  Most of the devices they have at the hospital are by Halyard, and I guess the staff did not know they were looking for something that was not Halyard.  Or something.  I really don’t know why they couldn’t find it.  The important thing is it got located, and I thought I was going to be out of there in just a few more minutes.

No.

I was wheeled into a room for the exchange.  The plan was to do it with no sedation, just a simple remove and replace.

Originally I was going to ask if we could video the process, or at least take photos.  But, after so much waiting to get to this point, and having not met any of the medical team previously, I decided to forgo this.  I did ask my attending if I could have the old tube once it was removed, and explained very briefly to him about Tube Chic.

There were two doctors, a couple of nurses, another doctor who was observing, and the anesthesiologist was handy, but not in the room after introducing herself initially.

None of the doctors had seen this device before.  They had the video demonstrating it, along with the written instructions by manufacturer up on the video screen behind me.  First one doctor would try using the actuator tool to straighten out the internal bumper so the button could be removed  While this was going on, the other doctor would be reading aloud, verifying they were doing it correctly.   No joy.  Over and over, they took turns.  I could feel something (and not pleasant) when the device would begin to change shape inside my stomach, but they could not get it to lengthen/flatten out enough to remove it.

Finally they called in the anesthesiologist.  The new plan was to use endoscopy to see what was going on from the inside.  If they could succeed in straightening out the bumper enough to remove from the outside they would, and if they couldn’t,  they would snip it from outside, catch the bumper with a tool from the inside, and pull it up out of my stomach via the esophagus.

With the visual assistance of the endoscopic camera, they were able to extend the internal bumper, and remove the button from the outside.

Once I was awake, my doctor came in to talk about what went on.  He said it took a lot more force than either of them had been willing to exert when trying before I was sedated.  In fact, he said it took substantial force to deploy the new button’s bumper.  He pointed out how all videos supplied by AMT showing how to remove/place this type of button are done using a mannequin.

Happily,  my stoma had no trauma as a result of all this.  I had a little tiny bit of pink oozing for the first day.  No granulation tissue formed  as a result, and I still have an exemplary example of what a stoma should ideally look like.  I have no exudate, redness or crusting.  I attribute this in part to how lightweight the AMT Mini One is. (If you, or the one you are caregiver of, have ongoing problems with granulation tissue, there is an entire section on how to combat this on Tube Chic.  Refer to the menu at the top of this page.)

My doctor  apologized that they did not save the old button, as he knew I’d wanted to post photos of it on Tube Chic.  He said it was pretty gross looking with a lot of brown slime on it.   But, he did take endoscopic photos.

Here is what the bumper looked like before they used the actuator to flatten it for removal:

Here it is once the tool has extended and flattened the bumper:

Here is the inside of my stomach showing the tract without any feeding tube in place.

Here is the  new button in place:

I did question how this looks, and he assured me that it is just the stomach mucosa obstructing the camera’s view of the left side.  The “slit” looking thing I really don’t know though.  I remember seeing the new button before I was sedated, and the bumper part had “pleats” because it was not deployed yet.  Whether this is just stomach goo stuck on it, or is a fissure I don’t know.  But they did not  seem concerned, and it is working perfectly fine, so I will accept that it is, in fact, perfectly fine.

All in all, my opinion of this specific type feeding tube has not changed.  I feel it is the best I’ve ever had.   It can be changed without trauma (pulling out through the stoma).  I am somewhat disappointed that exchanging them without sedation is not a good option though.   But, on the other hand, I was only under for a very few minutes. The timestamps on the endoscopy photos show that the entire process was  completed within less than five minutes total.

Here is a link to  more information on the AMT Mini One Capsule:

https://www.appliedmedical.net/gi-products/minione/cap-non-balloon/

[EDITED TO ADD doctor’s notes]

FINDINGS:

We attempted to exchange PEG at beside but could not, we then converted to a sedated, endoscopic procedure.  The old PEG bumper was visualized and then removed  with moderate to large force.  Then Applied Medical TEchnologies miniONE non balloon low profile feeding device was inserted into the stomach under direct visualization. Retroflexion was not performed. The mucosa was examined carefully as the instrument was withdrawn.  The scope was then completely withdrawn from the patient and the procedure completed.

 

 

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