R. E. Wilson1, P. K. Rao1, A. J. Cunningham1, S. Krishnaswami1, E. N. Dewey1, M. C. Boulos1, N. A. Hamilton1 1Oregon Health And Science University,Pediatric Surgery,Portland, OR, USA
Introduction:
Gastrojejunostomy (GJ) tubes are frequently used to provide enteral nutrition in patients who do not tolerate gastric feeds. GJ tubes are reported to have a high rate of minor complications, most commonly thought to be migration into stomach, requiring unplanned urgent interventions. However, there is currently insufficient literature on the lifespan of GJ tubes, reasons for failure, and recommendations for optimal techniques and timing of replacement. We aimed to evaluate the natural history of GJ tubes in pediatric patients to guide clinical management.
Methods:
We reviewed all pediatric patients who underwent GJ tube placement or exchange at our institution from January 2012 to July 2018. Demographic data was collected, as was time and indication for replacement or removal of GJ tubes. End points for the study include permanent removal of GJ tube or mortality. Current feeding status of each patient was also recorded.
Results:
Seventy-nine patients underwent 205 GJ tube procedures. Four had prior fundoplication. The tubes lasted a median of 98 days (interquartile range = 54-166) and patients had a median of 2 GJ tubes. The most common indication for tube change was a structural/mechanical problem with the tube, occurring 56 times (43.1%). These included broken balloons (27, 20.8%), loose connector rings (17, 13.1%) and tube plugging (9, 6.9%). Other indications for tube replacement included dislodgement of tube from tract (45, 34.6%), migration of tube into stomach or esophagus (11, 8.5%), routine change (9, 6.9%), or other (9, 6.9%). Thirty-four percent of tubes replaced were able to be performed without general anesthesia or sedation (Table 1).
Twelve patients (15.2%) died from their primary disease during the study period. Thirty-two patients (40.5%) ultimately tolerated gastric feeds. Nine (11.4%) of these patients required subsequent fundoplication. The remaining 23 patients (29.1%) progressed to gastric feeds without subsequent fundoplication. Conversion to gastric feeding without subsequent fundoplication occurred at a median time of 212 days.
Conclusion:
Gastrojejunostomy tubes offer a safe and effective feeding option in patients who do not tolerate gastric feeds. Most tubes fail due to intrinsic structural/mechanical issues and not secondary to migration into the stomach. No additional operative therapy is needed in 44% of patients, as many ultimately tolerate gastric feeds or suffer early mortality from their primary disease. Finally, exchange of GJ tubes without anesthesia is a viable option in many cases and can increase feasibility of long-term GJ use.
