Gastrojejunostomy tube complications - A single center experience and systematic review.
OBJECTIVE
Gastrojejunostomy tubes (GJTs) enable enteral nutrition in infants/children with feeding intolerance. However, complications may be increased in small infants. We evaluated our single-institution GJT complication rate and systematically reviewed existing literature.


METHODS
With REB approval, a retrospective single-institution analysis of GJT placements between 2009 and 2015 was performed. For the systematic review, MOOSE guidelines were followed.


RESULTS
At our institution, 48 children underwent 154/159 successful insertions primarily for gastroesophageal reflux (n=27; 55%) and aspiration (n=11; 23%). Median age at first GJT insertion was 2.2years (0.2-18). Thirty-five (73%) had an index insertion when ≤10kg. GJTs caused 2 perforations and 1 death. The systematic review assessed 48 articles representing 2726 procedures. Overall perforation rate was estimated as 2.1% (n=36 studies, 23/1092, 95% CI: 1.0-3.2). Perforation rates in children <10kg versus ≥10kg were estimated as 3.1%/procedure (95% CI: 1.1%-5.0%) and 0.1%/procedure (95% CI: 0%-0.3%), respectively. The relative risk of perforation was 9.4 (95% CI: 2.8-31.3). Overall mortality was estimated as 0.9%/patient (n=39 studies; 95% CI: 0.2-1.6%). Most perforations (19/23; 83%) occurred ≤30days of attempted tube placement.


CONCLUSIONS
Gastrojejunostomy tubes are associated with significant complications and frequently require revision/replacement. Insertion in patients <10kg is associated with increased perforation risk. Caution is warranted in this subgroup.


METHODS
Level II.
Divisions of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada.
James
J
Morse
Divisions of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada.
Robert
R
Baird
Pediatric Interventional Radiology, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada.
Karl
K
Muchantef
Pediatric Gastroenterology, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada.
Dominique
D
Levesque
Pediatric Gastroenterology, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada.
Veronique
V
Morinville
Divisions of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: pramod.puligandla@mcgill.ca.
Pramod S
PS
Puligandla
D000293:Adolescent; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007416:Intestinal Perforation / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors
Complication; Gastrojejunostomy tube; Infant; Pediatric; Perforation