title: Analysis of risk factors contributing to morbidity from gastrojejunostomy feeding tubes in children.
abstract: OBJECTIVE
  The purpose of this study was to define morbidity from gastrojejunostomy tube (GJT) placement in children.
  
  
  METHODS
  A retrospective single-center 5-year review of GJT placement in children was performed. Age, weight, prior surgery, indication, type of GJT, and complications (GJT replacement, wound complications, and perforation) were recorded. Logistic regression for morbidity was performed.
  
  
  RESULTS
  142 children underwent 394 GJT placements at a median age of 2.7years (range 5 weeks-18years). The most common indications were failure to thrive (62%) and reflux (25%). Among the 296 GJT replacements, the most common reason was tube dislodgement (30%). Risk factors for replacement, which occurred at a median interval of 12 weeks (range 2days-2.4years), were peristomal complaint (OR=5.4, p=0.02) and prior GJT replacement (OR=1.8, p=0.03). In all, 7 (5%) jejunal perforations occurred at a median of 3 days (range 0-21 days) from GJT placement. Patients with perforation had a median weight of 4.6kg (range 3-11.2kg) and age of 3.9months (range 8 weeks-2.1years). Lower weight (p<0.01) and younger age (p=0.02) predicted perforation, with those weighing less than 6kg (OR=51.9, p<0.001) or younger than 6months (OR=28.6, p<0.01) at highest risk.
  
  
  CONCLUSIONS
  GJT placement has a significant risk of recurrent dislodgement and the highest risk of perforation in children weighing less than 6kg or younger than 6months. Alternate feeding options should be strongly considered in this vulnerable population.
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Farokh R
authors.initials: FR
authors.lastname: Demehri
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Siddartha
authors.initials: S
authors.lastname: Simha
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Emma
authors.initials: E
authors.lastname: Herrman
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Jarboe
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: James D
authors.initials: JD
authors.lastname: Geiger
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Teitelbaum
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, University of Michigan Health System, Ann Arbor, MI. Electronic address: samirg@med.umich.edu.
authors.forename: Samir K
authors.initials: SK
authors.lastname: Gadepalli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D009017:Morbidity; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Enteral access; Feeding tube; Gastrojejunostomy; Pediatric; Perforation