title: The limitations of gastro-jejunal (G-J) feeding tubes in children: a 9-year pediatric hospital database analysis.
abstract: BACKGROUND
  A gastro-jejunal (G-J) feeding tube is a safe and useful temporizing method of providing enteral access in children. Although G-J tubes are often used to obviate the need for a surgical jejunostomy, their long-term use is often associated with mechanical failure.
  
  
  OBJECTIVE
  To review the clinically effective durability of G-J feeding tubes in providing enteral access in children.
  
  
  METHODS
  We performed a retrospective review of 102 patients at the Johns Hopkins Children's Center from 1994-2003 whose underlying diagnosis necessitated the need for postpyloric enteral access.
  
  
  RESULTS
  Long-term follow-up was obtained in 85 (48 M; 37 F) patients with a median (range) age of 2.0 (0.1-18.0) yr. The most common indication for G-J tube placement was gastroesophageal reflux with aspiration in 51 patients and feeding intolerance and vomiting in 19 patients. The mean (range) number of tube replacements was 2.2 (1-14) over a median (range) duration of follow-up of 39 (2-474) days. The indication for G-J tube replacement included: tube displacement (58), a clogged tube (41), and a cracked tube or ruptured balloon (35). In 52 cases, the cause for G-J tube replacement was undetermined.
  
  
  CONCLUSIONS
  G-J feeding tubes are associated with the frequent need for tube maintenance and replacement and may not be the most feasible clinical option in providing long-term (>1 month) enteral access in children intolerant to gastrostomy tube feeds. Future studies are needed to develop innovative percutaneous jejunostomy tube placement techniques that facilitate long-term enteral access.
authors.affiliation: Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287-2631, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Fortunato
authors.forename: Anil
authors.initials: A
authors.lastname: Darbari
authors.forename: Sally E
authors.initials: SE
authors.lastname: Mitchell
authors.forename: Richard E
authors.initials: RE
authors.lastname: Thompson
authors.forename: Carmen
authors.initials: C
authors.lastname: Cuffari
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000009:adverse effects*; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal; D007582:Jejunostomy; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome