I. Campwala1, E. Perrone1, G. Yanni2, M. Shah2, G. Gollin1 1Loma Linda University School Of Medicine,Pediatric Surgery,Loma LInda, CA, USA 2Loma Linda University School Of Medicine,Pediatric Gastroenterology,Loma LInda, CA, USA
Introduction: Long-term gastrojejunal (GJ) feeding is an increasingly popular alternative to gastric fundoplication for children with pathological reflux, particularly in patients with neurological impairment. We sought to evaluate the morbidity associated with GJ feeding tubes in a large population of children.
Methods: The records of all children under 18 years of age who underwent placement of a GJ feeding tube in a large children’s hospital between January, 2005 and September, 2012 were reviewed. Subjects were followed for an average of 5 years (range, 2-9 years). The indications for GJ feedings were noted. Events including a requirement for tube replacement, small bowel obstruction requiring laparotomy, intestinal perforation, and a subsequent requirement for operative jejunostomy were evaluated. Risk factors for morbidity were assessed.
Results: 124 children underwent GJ tube placement during the study period at an average age of 5.0 years (range, 2 months to 16 years). 51 (41%) subjects were neurologically impaired and 55 (44%) had undergone prior laparoscopic fundoplication. Recurrent reflux symptoms occurred in 22 (18%). Tubes were electively changed under sedation an average of 4 times per child and jejunal limbs dislodged 1.2 times per patient and more than 3 times in 17 (14%). In 9 cases (7%), an operative jejunostomy was constructed due to difficulties with GJ feeding. Five children (4%) required emergent laparotomy for GJ tube complications including intestinal obstruction (2) and intestinal perforation (3). These subjects were younger (9 months) than those without complications that required laparotomy (5.2 years, p=0.05).
Conclusion: GJ feeding tubes were associated with notable morbidity ranging from persistent reflux to dislodgement, intestinal obstruction and perforation. Together with issues of inconvenience with continuous feedings, these complications should be taken into account in children, and particularly infants, with gastroesophageal reflux in whom GJ feedings are being considered as an alternative to fundoplication.