Frequency and Methods of Gastrojejunal Tube Replacement in Children

Abstract

Gastrojejunal (GJ) tubes are increasingly used for enteral feeding in children in whom gastric feeding either is not tolerated or is contraindicated. The most common complications associated with GJ tube use are mechanical failure (clogging, cracking, deterioration) and dislodgement. Less common, but more significant, complications are bowel perforation, aspiration, and feeding intolerance. Some of these complications may be prevented by replacing GJ tubes at regular intervals. Methods to direct a GJ tube include 1) guidewire, 2) gastroduodenoscopy-guidewire, 3) esophagogastroduodenoscopy-forceps, and 4) fluoroscopy-guidewire. Clinical experience to determine the ideal method and optimal timing of GJ tube replacement is evolving. GJ tube replacement using a guidewire through the prior GJ tube, without endoscopy, fluoroscopy, or sedation, is the least risky method, but is also the least likely to be successful.

Clinical management of post-pyloric enteral feeding in children

“…Frequent clogging of the jejunal portion of the tube is the most common problem encountered during JF [56, [80][81][82]. Regular replacement of the nasoenteric tubes may prevent clogging; however, the optimal interval is not known.…”

“…Regular replacement of the nasoenteric tubes may prevent clogging; however, the optimal interval is not known. Some authors routinely change tubes at about 3-4 months intervals [82]. Tube Table 1.…”

“…The tip of the tube was placed approximately 40 cm down the jejunum to maintain pancreatic rest. Only one patient did not tolerate feeding and needed to Leakage Narrow tubes, poor healing of the stoma, decreased volume of the gastric balloon Increase of fluid in the gastric balloon, topical treatment (barrier creams), switching to a wider tube [82] Duodenogastric reflux Short tubes, intestinal dysmotility, distal obstruction Prokinetic drugs, longer jejunal tubes, exclusion of distal obstruction [75][76][77][78] Aspiration Due to vomiting of gastric contents Antisecretory drugs, small volume of fluids with drugs, gastric decompression [74,76,78,79] Bowel perforation Migration of tube due to intestinal peristalsis (observed mainly in malrotated patients)…”

Gastrojejunostomy Tube Bowel Perforations in Low‐Weight Infants

“…In recent decades, gastrojejunostomy tubes (GJTs) have become an alternative for patients who require enteric feeding but have gastric feeding intolerance. Patients with conditions such as gastroparesis, microgastria, gastroesophageal reflux disease (GERD), and those in which fundoplication either is unsuccessful or is not an option are candidates for GJT insertion 1 , 2 . GJTs are a favorable alternative in these patients as surgery may be contraindicated, either because of unique anatomy (eg, microgastria in patients with esophageal atresia) or because of other comorbidities.…”

“…However, delayed perforations in the period following the insertion of GJTs are rarely described in the literature 3 , 4 . The risk of bowel perforation caused by GJT insertion is reported to be 1%–2% 1 , 2 . The risk of bowel perforation may be higher in young infants who have a relatively narrow bowel caliber and a thin bowel wall 5 .…”