Download PDF
Eur J Pediatr Surg 2018; 28(03): 293-296
DOI: 10.1055/s-0037-1603526
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Feeding Jejunostomy: Is It a Safe Route in Pediatric Patients? Single Institution Experience

Francesco Fascetti-Leon
1   Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padova, Italy
2   Department of Pediatric Surgery, Chelsea and Westminster Hospital, NHS Foundation Trust, London, United Kingdom
,
Hisham El Agami
2   Department of Pediatric Surgery, Chelsea and Westminster Hospital, NHS Foundation Trust, London, United Kingdom
,
Dalia Gobbi
3   Department of Pediatric Surgery, Ospedale Cà Foncello, Treviso, Italy
,
Simon Clarke
2   Department of Pediatric Surgery, Chelsea and Westminster Hospital, NHS Foundation Trust, London, United Kingdom
,
Munther Haddad
2   Department of Pediatric Surgery, Chelsea and Westminster Hospital, NHS Foundation Trust, London, United Kingdom
,
Muhammad Choudhry
2   Department of Pediatric Surgery, Chelsea and Westminster Hospital, NHS Foundation Trust, London, United Kingdom
› Author Affiliations Funding None.
Further Information

Publication History

29 January 2017

18 April 2017

Publication Date:
23 May 2017 (online)

    Permissions and Reprints

Abstract

Introduction Impossibility to place a gastrostomy and failed gastroesophageal reflux surgery with unsafe swallow are the main indications to Feeding Jejunostomy (FJ) in children. The aim of this study is to quantify the incidence of complications associated with FJ.

Materials and Methods A retrospective review of patients who had surgically inserted FJ between January 2009 and August 2013 at our institution was conducted. Data were obtained from medical records, operative notes, and radiology database, focusing on complications.

Results A total of 19 patients, average age 39.6 months (3–168 months), were treated during the study period. Indications to FJ were gastroesophageal reflux disease (GERD) associated with unsafe swallow in 12, esophageal atresia in 5, and foregut dysmotility in 2. Seventeen FJ were inserted via laparotomy and 2 were laparoscopically assisted. In all cases, a serosal tunnel on the antimesenteric border was fashioned. No intraoperative complications were recorded. Tube dislodgement/blockage occurred on an average of 0.48 times per month in 18 out of 19 patients. The average radiation dose received for tube reinsertion/manipulation was 3.316 mSv/year/patient (0–10.66). Major postoperative complications occurred in 7 out of 19. After an average follow-up of 21 months, two have abandoned the use of FJ due to poor tolerance and three have fully weaned off. Two patients died due to unrelated causes.

Conclusion FJ, as an alternative means for enteral feeding, may require multiple readmissions and exposure to radiological procedures. The high risk of severe complications should be considered when offering this procedure.

Keywords

postpyloric feeding - feeding jejunostomy - surgical jejunostomy - gastroesophageal reflux - gastrostomy
 

  • References

  • 1 Raval MV, Phillips JD. Optimal enteral feeding in children with gastric dysfunction: surgical jejunostomy vs image-guided gastrojejunal tube placement. J Pediatr Surg 2006; 41 (10) 1679-1682
    CrossrefPubMedGoogle Scholar
  • 2 Williams AR, Borsellino A, Sugarman ID, Crabbe DC. Roux-en-Y feeding jejunostomy in infants and children. Eur J Pediatr Surg 2007; 17 (01) 29-33
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Braegger C, Decsi T, Dias JA. , et al; ESPGHAN Committee on Nutrition. Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr 2010; 51 (01) 110-122
    CrossrefPubMedGoogle Scholar
  • 4 Gilchrist BF, Luks FI, DeLuca FG, Wesselhoeft Jr CW. A modified feeding Roux-en-Y jejunostomy in the neurologically damaged child. J Pediatr Surg 1997; 32 (04) 588-589
    CrossrefPubMedGoogle Scholar
  • 5 Jester I, Singh M, Parikh DH. A novel technique of permanent self-catheterizable feeding jejunostomy. J Pediatr Surg 2012; 47 (04) 812-814
    CrossrefPubMedGoogle Scholar
  • 6 Egnell C, Eksborg S, Grahnquist L. Jejunostomy enteral feeding in children: outcome and safety. JPEN J Parenter Enteral Nutr 2014; 38 (05) 631-636
    CrossrefPubMedGoogle Scholar
  • 7 Esposito C, Settimi A, Centonze A, Capano G, Ascione G. Laparoscopic-assisted jejunostomy: an effective procedure for the treatment of neurologically impaired children with feeding problems and gastroesophageal reflux. Surg Endosc 2005; 19 (04) 501-504
    CrossrefPubMedGoogle Scholar
  • 8 Berrington de González A, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 2004; 363 (9406): 345-351
    CrossrefPubMedGoogle Scholar
  • 9 Wani ML, Ahangar AG, Lone GN. , et al. Feeding jejunostomy: does the benefit overweight the risk (a retrospective study from a single centre). Int J Surg 2010; 8 (05) 387-390
    CrossrefPubMedGoogle Scholar
  • 10 Garrett-Cox R, Richards CA, Misra D. Severe jejunoileitis after placement of a feeding jejunostomy: a series of four cases and a review of the literature. J Pediatr Surg 2003; 38 (07) 1090-1093
    CrossrefPubMedGoogle Scholar
  • 11 Showalter CD, Kerrey B, Spellman-Kennebeck S, Timm N. Gastrostomy tube replacement in a pediatric ED: frequency of complications and impact of confirmatory imaging. Am J Emerg Med 2012; 30 (08) 1501-1506
    CrossrefPubMedGoogle Scholar
  • 12 Smith D, Soucy P. Complications of long-term jejunostomy in children. J Pediatr Surg 1996; 31 (06) 787-790
    CrossrefPubMedGoogle Scholar
  • 13 Speer EA, Chow SC, Dunst CM. , et al. Clinical burden of laparoscopic feeding jejunostomy tubes. J Gastrointest Surg 2016; 20 (05) 970-975
    CrossrefPubMedGoogle Scholar