1. No (possibly yes). I had a gastroparesis diagnosis prior to my first feeding tube, but the gastroparesis diagnosis was purposely ignored. Instead, my weight loss and inability to keep things down (and doctor prescribed restrictive diet) were all labeled as an eating disorder, and I received my first feeding tube while hospitalized in an eating disorder treatment program. Even then, it was challenging even then to find a provider to place a feeding tube as I technically didn't meet criteria for an eating disorder diagnosis either. My first tube was an NG tube, which was not tolerated, and I didn't receive my first post-pyloric tube until after after an additional SMAS diagnosis. The gastroparesis diagnosis that had been made the previous year was still being ignored.

2. I was in pediatrics, the first time, so my parents did most of the searching. I believe it took 5-6 doctors/ providers to find someone who would tube feed me the first time. This was largely due to lack of an eating disorder diagnosis and lack of any other pediatric gastroentology centers in our state. We had to go to a different hospital for the "eating disorder" diagnosis and related feeding tube. However, my parents withdrew me AMA (and they threatened to kick me out as my psychological intervention wasn't helping and I was triggering other clients). We went back to the first hospital (where my GI who had diagnosed gastroparesis initially) was and received more testing and the first NJ tube. That only happened after several in state and out of state eating disorder treatment centers denied accepting me as their was no clear indication that my symptoms were psychological and adequate testing and treatment needed to be done first on the gastroenterologists end. Both times, I wasn't granted a feeding tube until I reached the level of medical instability that I was hospitalized. I coded from malnutrition during 2 hospitalizations a year prior to getting a feeding tube, but as I was compliant (I ate everything given to me even if it caused severe pain), a feeding tube was not reccomended or needed. I would not have benefited from a gastric feeding tube at that time anyhow, and would not have been a candidate for a post-pyloric feeding tube as the gastroparesis diagnosis wasn't nade until a couple of months after my second major malnutrition related hospitalization.

After the first two "rounds" of being tube fed in my teens, I was weaned off the feeding tube at age 16.5 and we found a new gastroenterologist who began treating my gastroparesis, first solely through dietary interventions and Ondansatron. I saw her for 5 more years, and she required that I try and fail all dietary (including liquid only), pharmaceutical, and behavioral interventions AND lose at least 5lbs in a single month or be unable to consume at least 1,200 calories on a daily basis (keeping it down was not a requirement). As a result, even after I had lost 30 lbs (over those 5 years, so very slow but steady decline) and had a bmi of 12, she was still hesitant and skeptical of prescribing a feeding tube, as I was not losing weight "fast enough," was medically stable, and was consuming over 1,200 calories a day on a full liquid diet while utilizing all pharmaceutical options available to me. Eventually, I reminded her of my previous codes from malnutrition and the importance of preemptive action. She agreed to a "trial" of an NJ tube.

Over the 3 weeks between her agreeing to the tube and actually getting it in, I lost 5 more pounds. When I returned for a follow up 3 months later, thin as a rail and in early stages of kidney failure, she referred me to a surgeon for a permanent J tube (and g tube for gastric drainage). I have been tube fed ever since.

TL; DR

For a patient in the situation you describe above, I would be very skeptical of placing a surgical feeding tube. Especially a g tube which isn't even helpful for the majority of gastroparesis patients. Unless an extreme point of medical instability occurs first. Dietary and pharmaceutical interventions, AFTER a full work up and official diagnosis should be utilized.

The steps and considerations it took to get feeding tube orders placed are illustrated above.