One‐step Percutaneous Gastrojejunostomy in Early Infancy

Abstract

In certain conditions that obviate the use of gastric feedings, the insertion of a jejunal feeding tube via gastrostomy constitutes an alternative to jejunostomy but requires a preexisting gastrostomy. Our aim was to assess a new technique of 1-step gastrojejunal tube insertion through a de novo gastrostomy. A total of 3 infants between 3 and 7 months old and weighing between 4.1 and 5.4 kg had a gastrojejunal feeding tube inserted using a 16-CH French introducer percutaneous endoscopic gastrostomy kit and a transgastric-jejunal feeding tube. No technical difficulties occurred and the gastrojejunal feeding tube was placed successfully in the 3 patients, the total procedure lasting 15 to 20 minutes. Enteral feeding was started within 4 to 6 hours of the procedure. Neither immediate (<24 hours) nor late complications related to the gastrojejunostomy occurred. Nissen fundoplication was performed in 2 of our patients at 12 and 15 months of age, respectively. The gastrojejunostomy tube was still in place in the third patient at age 15 months. Our first experience suggests that 1-step endoscopic placement of a transgastric-jejunal feeding tube without a preexisting gastrostomy tract is feasible in young and low-weight infants.

Jejunal Feeding by Gastrojejunal Tube in Pediatric Refractory Gastroesophageal Reflux Disease

“…However, parenteral nutrition rate significantly decreased from 54% to 17% of patients and a majority (70%) of patients were successfully transitioned to gastric feeding at endpoint. These results are better than most of previous studies which reported 7%–43% of successful transition to gastric feeding (7–11,13,15–18). As these reports did not study patients after GJT removal, the frequency of jejunal nutrition weaning could be underestimated.…”

“…GJTs were placed with endoscope-assisted technique with peroperative fluoroscopy following the previously reported technique (13). GJT placement was considered successful if its tip was distal to the third portion of the duodenum.…”

Surgical Interventions for Infant and Childhood Gastroesophageal Reflux Disease

“…Although placement of a percutaneous endoscopic gastrostomy (PEG) followed by exchange for a GJ tube is the least invasive approach to obtain post-pyloric feeds, exchange must occur after the stoma matures, delaying the initiation of feeds by 6-8 weeks. [9][10][11] More recently, a variety of techniques for minimally invasive primary placement have evolved including percutaneous placement as well as the use of laparoscopy, fluoroscopy and endoscopy. These approaches allow for immediate feeding however they do not mitigate the common struggle to intubate the pylorus and prevent tube dislodgement during placement.…”

The Use of Jejunal Tube Feeding in Children

“…One-step GJT insertion through a de novo gastrostomy is a recent technique using the push technique. The procedure is basically the same as the 1-step percutaneous endoscopy button placement (76) where a neonatoscope is introduced through the 16-French introducer and passed into the jejunum via the pylorus and a GJT is placed over the guidewire as described above (77).…”