Surgical jejunostomy and radiological gastro-jejunostomy tube feeding in children: risks, benefits and nutritional outcomes

Singh, Rashmi R.; Eaton, Simon; Roebuck, Derek; Barnacle, Alex; Chippington, Samantha; Cross, Kate; Coppi, Paolo De; Curry, Joe

doi:10.1007/s00383-018-4303-8

Cited by 12 publications

(15 citation statements)

References 27 publications

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“…Our previous series [2] which showed stable nutritional outcomes in jejunally fed patients; in our current cohort of patients, the median increase in weight in those who had the second fundoplication with interim GJ feeds after the failed first fundoplication was 5 kg. This was more than those done without the interim NJ feeds (3.75 kg).…”

Section: Discussionsupporting

confidence: 46%

“…The pooled rate of reoperation following failed fundoplication in children with neurological impairment being 15%, and 7% in children without neurological impairment [1]. Whist jejunal feeding has been proved to be a reasonable alternative to redo fundoplication [2] with good nutritional outcomes, it has inherent morbidities such as the need for continuous feeding, tube dislodgement / blockage We reviewed our experience of such patients in the current study.…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes following failure of Nissen fundoplication

et al. 2022

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Purpose: To determine the management and outcomes of patients with gastro-oesophageal reflux (GOR) that require further intervention following failure of Nissen Fundoplication (NF).Methods: After institutional audit department approval, a retrospective review of paediatric patients who had further intervention following failure of primary NF between January 2006 and December 2015 for GOR at our centre was performed. Data is presented as median (range).Results: Of 820 patients who underwent NF, 190 (23%) received further procedures for GOR management at a median of 21 months of age (6-186); 90/190 (47%) had gastrojejunal feeding (GJ). Of these 67 (74%) remained on GJ feeds up to a median of 48 months and 23/90 (26%) had a second NF after GJ feeding. 97/190 (51%) had a redo fundoplication without having had a GJ; thus 120/190 (63%) of patients having a further procedure went on to have a second NF after a median period of 15 months (1-70 months). Three patients (2%) had early emergency wrap revision 4 days after first fundoplication (we classed this as an 'early complication'). Of the seven patients who failed a 3 rd NF, 4 continued GJ feeding, 2 of had oesophogastric dissociation; 2 had 4 th NF of which 1 was successful and 1 patient had gastric pacemaker and is successfully feeding orally. Patients who were finally successfully managed with GJ underwent 2 (2-5) tube changes/year. We found patients who had a previous GJ were more likely to have failure of the redo fundoplication than those who had not to have the GJ (16/24 vs. 30/90, p=0.005). Conclusion:The chance of success decreases with every further attempt at fundoplication. The only factor significantly associated with failure of redo fundoplication was whether the patient previously had a GJ tube. In patients with failed fundoplications, when symptom free on jejunal feedings, further anti-reflux surgical intervention should be avoided. A randomized prospective study is needed for patient selection.

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Section: Discussionsupporting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Long-term outcomes following failure of Nissen fundoplication

et al. 2022

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“…Recently, a systematic review comparing these publications was published [ 20 ]. Open surgery is associated with a different type (more severe) and a higher rate of complications compared to the LRFJ, as there is a high (6–40%) incidence of wound infections [ 17 , 23 , 24 ] and volvulus (14–25%) [ 24 – 26 ] compared to respectively 8% and 0% in our patient population. Despite this difference, the open jejunostomy showed, as expected, the same complications related to the jejunostomy site as the laparoscopic jejunostomy site: leakage (17–43%) [ 4 , 17 , 23 ] and hypergranulation (no percentages available) [ 27 ].…”

Section: Discussionmentioning

confidence: 83%

“…In one patient with a volvulus the Roux limb was only 6 cm [ 25 ]. In the studies of McCann et al and Singh et al no details about Roux limb length were described but all patients with volvulus received open surgery [ 24 , 26 ]. In our series, the Roux limb was relatively short (10–15 cm).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Roux-en-Y feeding jejunostomy as a long-term solution for severe feeding problems in children

et al. 2022

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Enteral feeding is a common problem in children with gastric emptying disorders. Traditional feeding methods in these patients often show a high rate of complications and maintenance issues. Laparoscopic Roux-en-Y feeding jejunostomy (LRFJ) has been described in a few patients as a minimal invasive option for enteral access in these children. The aim of this study is to evaluate the outcomes of the LRFJ procedure in our tertiary referral center. We conducted a retrospective case-series including all patients, aged 0–18 years old, that underwent a LFRJ procedure between August 2011 and December 2020 for the indication of oral feeding intolerance due to delayed gastric emptying. Outcomes evaluated were complications (short and long term) and parenteral satisfaction. In total, 12 children were identified that underwent LRFJ for the indication of oral feeding intolerance due to delayed gastric emptying. A total of 16 complications were noted in 8/12 patients (67%). Severity classified by Clavien-Dindo were grade I (n = 13), grade II (n = 1), and grade IIIB (n = 2). In 11/12 patients, parents were satisfied with the results. Conclusions: Although minor complications after LRFJ are common in our patients, this technique is a safe solution in patients with gastric emptying disorders leading to a definitive method of enteral feeding and high parenteral satisfaction. What is Known:• Traditional tube feeding in children (duodenal, PEG-J-tubes) with severe delayed gastric emptying can be challenging with a high rate of complications and maintenance issues.• Open loop jejunostomy and Roux-en-Y jejunostomy are alternative, permanent methods of feeding but either invasive or are accompanied by severe complications. Little is known in the literature about laparoscopic Roux-en-Y feeding jejunostomy. What is New:• Laparoscopic Roux-en-Y feeding jejunostomy is a permanent, safe and minimal invasive alternative option for enteral feeding in children with severe delayed gastric emptying..

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“…An appropriate linear growth was not achieved in our study. Compared with other GT ( 33 ), percutaneous endoscopic GT (PEG) ( 34 ), and the surgical jejunostomy (SJ) studies ( 35 ), our patients had similar weight-for-age z -score improvement from −4.02 to −3.42 in 1 year in NE tube feeding, from −2.8 to −1.8 in 1 year in GT, from −1.5 to 0.9 in 6 months in PEG, and from −3.7 to −2.6 in 1 year in SJ. In addition, we analyzed the growth of patients who subsequently received surgical GT ( N = 8) and fundoplication ( N = 7) and showed a decrease in weight-for-age z -score from −2.76 ± 1.73 to −3.25 ± 2.91 and an increase in height-for-age z-score from −3.34 ± 2.35 to −3.19 ± 2.60 during follow-up for 1,164.3 ± 697.7 days.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Efficacy of Nasoenteric Tube Feeding in Children Needing Enteral Nutrition

et al. 2021

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Background: There is limited information on therapeutic benefits and tube-related complications of pediatric nasoenteric (NE) tube feeding. We viewed, from different clinical aspects, NE tube feeding in children who are under intolerable conditions.Methods: A 10-years retrospective study enrolled 77 pediatric patients who underwent an endoscopic-guided placement of the NE tube for enteral nutrition. The evaluated data, including growth parameters, feeding volume, parenteral nutrition (PN) dependence, and nutritional markers [serum hemoglobin (Hb) and albumin] before and after NE tube feeding were compared. Tube-related complications and major adverse events were also recorded.Results: A total of 77 patients (including 50 males) underwent 176 endoscopic-guided placements of the NE tube with an average duration of 133.7 (6.0–1,847.3) days. The gastroesophageal reflux disease-related symptoms (vomiting, desaturations, and aspiration pneumonia) improved in 71.4% of patients. Feeding volume increased significantly after intervention, especially in patients with delayed gastric emptying, from 144.8 ± 28.5 to 1,103.1 ± 524.7 ml/days (p < 0.001). Weaning from PN was successfully achieved in 84.3% of patients with an average of 9.33 ± 7.30 days. About 16 patients (20.8%) were subsequently highly compatible with oral feeding after NE tube placement for an average of 24.7 ± 14.1 days. Patients either without neurologic dysfunction or with no ventilator-dependent status had a higher chance of shifting to oral feeding. Weight-for-age z-scores increased by 0.15 ± 1.33 after NE tube intervention. One NE tube-related adverse event, which caused bowel perforation at 6 days post-insertion, was recorded. No direct tube-related mortality was observed.Conclusions: Endoscopic-guided NE tube placement is a relatively safe, non-invasive procedure for pediatric patients who require enteral nutrition. Feeding via NE tube showed beneficial effects such as improvement in symptoms, PN weaning, and maintenance of body growth without major tube-related complications.

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Surgical jejunostomy and radiological gastro-jejunostomy tube feeding in children: risks, benefits and nutritional outcomes

Cited by 12 publications

References 27 publications

Long-term outcomes following failure of Nissen fundoplication

Long-term outcomes following failure of Nissen fundoplication

Laparoscopic Roux-en-Y feeding jejunostomy as a long-term solution for severe feeding problems in children

Therapeutic Efficacy of Nasoenteric Tube Feeding in Children Needing Enteral Nutrition

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