Endoscopic Gastrojejunostomy in Infants and Children

Sophia Elmehdi; Delphine Ley; Madeleine Aumar; Stéphanie Coopman; Dominique Guimber; Audrey Nicolas; Matthieu Antoine; Dominique Turck; Maeva Kyheng; Frédéric Gottrand

doi:10.1016/j.jpeds.2022.01.039

Endoscopic Gastrojejunostomy in Infants and Children

J Pediatr. 2022 May:244:115-119.e1. doi: 10.1016/j.jpeds.2022.01.039. Epub 2022 Jan 31.

Affiliations

¹ Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France. Electronic address: elmehdi-s@ch-valenciennes.fr.
² Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France; Inserm, U1286, Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France.
³ Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France.
⁴ Division of Methodology, Biostatistics, and Data Management, University of Lille, CHU Lille, Lille, France.

PMID: 35108546
DOI: 10.1016/j.jpeds.2022.01.039

Abstract

Objective: To evaluate the feasibility of endoscopic gastrojejunal tube (GJT) placement in infants and children.

Study design: All children undergoing endoscopic GJT placement between January 2010 and December 2019 were included in this single-center retrospective study. Difficulties with and failure of GJT placement, complication rates, and device longevity, efficacy, and duration were assessed.

Results: A total of 107 children, median age 10 months (IQR, 5.0-23.0 months) and median weight 6.6 kg (IQR, 5.3-9.5 kg), underwent endoscopic GJT placement using the gastric stoma to introduce the endoscope (one step: n = 36 of 107; 33.6%). Endoscopic placement was successful in 99%. Eight periprocedure complications occurred, including 1 pneumoperitoneum requiring exsufflation, 2 acute pulmonary hypertension episodes leading to death in 1 case, and 5 episodes of bronchospasm. Minor complications were frequent and mostly mechanical (79%), whereas major complications were rare (5.6%): intussusception (n = 4), intestinal perforation (n = 1), and pneumoperitoneum (n = 1). Ten patients died. Of the 97 patients who lived, 85 (87%) were weaned from jejunal feeding at a median of 179 days (IQR, 69-295 days) after initiation. Among them, 30 (35.2%) required fundoplication. Weight for age z-score was significantly higher at weaning.

Conclusions: GJT placement is feasible in children, even low-weight infants. Complications are frequent but are mostly minor.

MeSH terms

Child
Enteral Nutrition / methods
Gastric Bypass* / methods
Gastrostomy
Humans
Infant
Intubation, Gastrointestinal / methods
Pneumoperitoneum* / etiology
Pneumoperitoneum* / surgery
Retrospective Studies