Limitations and uses of gastrojejunal feeding tubes.
BACKGROUND
Gastrostomy feeding is a well established alternative method to long term nasogastric tube feeding. Many such patients have gastro-oesophageal reflux (GOR) and require a fundoplication. A transgastric jejunal tube is an alternative when antireflux surgery fails, or is hazardous or inappropriate.


OBJECTIVE
To review experience of gastrojejunal (G-J) feeding over six years in two regional centres in the UK.


METHODS
Retrospective review of all children who underwent insertion of a G-J feeding tube.


RESULTS
There were 18 children, 12 of whom were neurologically impaired. G-J tubes were inserted at a median age of 3.1 years (range 0.6-14.7) because of persistent symptoms after Nissen fundoplication (n = 8) or symptomatic GOR where fundoplication was inappropriate. Four underwent primary endoscopic insertion of the G-J tube; the remainder had the tube inserted via a previous gastrostomy track. Seventeen showed good weight gain. There was one insertion related complication. During a median follow up of 10 months (range 1-60), four experienced recurrent aspiration, bilious aspirates, and/or diarrhoea. There were 65 tube related complications in 14 patients, necessitating change of the tube at a median of 74 days. Jejunal tube migration was the commonest problem. Five died from complications of their underlying disease.


CONCLUSIONS
Although G-J feeding tubes were inserted safely and improved nutritional status, their use was associated with a high rate of morbidity. Surgical alternatives such as an Roux-en-Y jejunostomy may be preferable.
Godbole
P
P
Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Margabanthu
G
G
Crabbe
D C
DC
Thomas
A
A
Puntis
J W L
JW
Abel
G
G
Arthur
R J
RJ
Stringer
M D
MD
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D004868:Equipment Failure; D005764:Gastroesophageal Reflux / Q000178:diet therapy*; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome; D015430:Weight Gain