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

Leon, Francesco Fascetti; Agami, Hisham El; Gobbi, Dalia; Clarke, Simon A.; Haddad, Munther J.; Choudhry, Muhammad

doi:10.1055/s-0037-1603526

Cited by 10 publications

(8 citation statements)

References 13 publications

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“…Twenty-four studies were retrieved for detailed evaluation. Table 1, Supplemental Digital Content (http://links.lww.com/MPG/C641) lists subsequently excluded studies after detailed evaluation (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and reasons for exclusion. Ultimately, 10 eligible studies (11,12,16,(31)(32)(33)(34)(35)(36)(37) were included for the final systematic review.…”

Section: Resultsmentioning

confidence: 99%

Is Roux‐en‐Y Feeding Jejunostomy a Safe and Effective Operation in Children? A Systematic Review Exploring Outcomes

Cullis

Buckle²,

Losty³

2021

J. pediatr. gastroenterol. nutr.

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Objectives: Roux-en-Y jejunostomy (REYJ) may establish feeding in children with foregut dysmotility or severe gastro-esophageal reflux disease (GERD). Nevertheless, concerns have been raised about safety and efficacy. We, therefore, evaluated outcomes of REYJ by systematic review to determine if this was a satisfactory option for achieving enteral autonomy in children with complex nutritional needs. Methods: A PRISMA-adherent systematic review was conducted of studies reporting children undergoing feeding REYJ. Two authors performed processes independently; the senior author resolved disagreements. Embase, CINAHL and Medline were searched (inception-01/21). Additional databases, references, and 'grey' literature were searched. Methodological Index for Non-randomized Studies (MINORS) and a bespoke system assessed methodological quality. Results: Of 362 articles, 10 met eligibility criteria (9 retrospective series; 1 conference proceeding). Unpublished data were also attained. Interobserver agreement for MINORS (kappa ¼ 0.47) and bespoke scoring (kappa ¼ 0.58) were moderate. After consensus, median MINORS score was 37.5% (IQR 6.3%) and bespoke 50% (IQR 20.8%), indicating poor methodological quality. One hundred sixty-four patients were reported (age range: 2 months to 19 years). Time to full feeds and length of stay were inadequately reported but most achieved enteral autonomy. No studies reported patient/caregiver-questionnaires. Seventy-six complications were documented (Clavien-Dindo grading was infeasible). Morbidity included peristomal leakage (N ¼ 26), internal hernia/volvulus (N ¼ 8), and SSI (N ¼ 7). Thirty-eight patients died (2 procedure-attributable) during follow-up (range: 1 month to 15 years). Conclusions: Up to 50% patients experience complications after REYJ (often minor) with 23% patients dying during follow-up, often comorbidityattributable. REYJ can achieve enteral autonomy although parents/ caregivers of children should be counselled accordingly.

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Section: Resultsmentioning

confidence: 99%

Is Roux‐en‐Y Feeding Jejunostomy a Safe and Effective Operation in Children? A Systematic Review Exploring Outcomes

Cullis

Buckle²,

Losty³

2021

J. pediatr. gastroenterol. nutr.

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“…The concept of post-pyloric feeding by jejunal feeding tube (JFT) has been well described in children [24][25][26][27]. The ESPGHAN-NASPGHAN guidelines for gastrointestinal complications of EA include the long-term dependency on post-pyloric feeding as an indication for fundoplication (statement 8C) [28].…”

Section: Discussionmentioning

confidence: 99%

“…This approach is less invasive than other anti-reflux procedures and it is generally considered a temporary nutritional strategy to limit long-term parenteral nutrition, when the use of gastrostomy is not possible [27,[29][30][31].…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of Gastrojejunostomy Prior to Fundoplication in Severe Gastro-Esophageal Reflux Complicating Long-Gap Esophageal Atresia Repair: A Preliminary Study

et al. 2021

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Background: Gastro-esophageal reflux disease (GERD), requiring surgical correction, and nutritional problems are reported after long-gap esophageal atresia (LGEA) repair and might jeopardize the postoperative course in some babies. We report an exploratory evaluation of the role of transgastric jejunostomy (TGJ) as a temporary nutritional tool before surgery for GERD in LGEA. Methods: Seven infant patients operated on for LGEA with intra-thoracic gastro-esophageal junction (GEJ) and growth failure, requiring improvement in their nutritional profile in anticipation of surgery, were retrospectively evaluated. Post-surgical follow-up, including growth evolution, complications, and parental quality of life (QoL), were considered. Results: The TGJ was placed at a mean age of 8.6 ± 5.6 months. The procedure was uneventful and well-tolerated in all seven cases. At 6.6 ± 2.0 months after TGJ placement, significant weight gain (weight z-score −2.68 ± 0.8 vs −0.9 ± 0.2, p < 0.001) was recorded, allowing the GERD surgery to proceed. A significant difference in hospital admissions between 3 months before and post-TGJ insertion was noted (4.8 ± 0.75 vs. 1.6 ± 0.52, p < 0.01). A significant amelioration of QoL after TGJ placement was also recorded; in particular, the biggest improvements were related to parents’ perceptions of the general health and emotional state of their babies (p < 0.001). Conclusions: The placement of TGJ as a temporary nutritional tool in selected cases of LGEA could improve nutritional conditions and parental QoL before fundoplication, allowing successful surgical treatment of GERD to be carried out.

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“…7 A moderate proportion of children receiving JT feeding are reported to have a history of previous fundoplication (between 12% and 69%). 4,5,12,13 Table 2 classifies different indications for JT feeding. 1,[4][5][6][7][8][9][10] Individual patient circumstances and factors such as comorbidities or presence of underlying intestinal dysmotility should be considered in decision-making and counseling about goals of JT feeding, (for example, provision of complete nutrition requirements in children with severe GORD and aspiration vs partial or trophic feeding, and medication administration in pediatric intestinal pseudo-obstruction).…”

Section: Patient Selectionmentioning

confidence: 99%

A clinical consensus paper on jejunal tube feeding in children

McGrath,

Collins,

Comerford

et al. 2024

J Parenter Enteral Nutr

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BackgroundFeeding problems are common in children with complex medical problems or acute critical illness and enteral nutrition may be required. In certain situations, gastric tube feeding is poorly tolerated or may not be feasible. When feed intolerance persists despite appropriate adjustments to oral and gastric enteral regimens, jejunal tube feeding can be considered as an option for nutrition support.MethodsA multidisciplinary expert working group of the Australasian Society of Parenteral and Enteral Nutrition was convened. They identified topic questions and five key areas of jejunal tube feeding in children. Literatures searches were undertaken on Pubmed, Embase, and Medline for all relevant studies, between January 2000 and September 2022 (n = 103). Studies were assessed using National Health and Medical Research Council guidelines to generate statements, which were discussed as a group, followed by voting on statements using a modified Delphi process to determine consensus.ResultsA total of 24 consensus statements were created for five key areas: patient selection, type and selection of feeding tube, complications, clinical use of jejunal tubes, follow‐up, and reassessment.ConclusionJejunal tube feeding is a safe and effective means of providing nutrition in a select group of pediatric patients with complex medical needs, who are unable to be fed by gastric tube feeding. Appropriate patient selection is important as complications associated with jejunal tube feeding are not uncommon, and although mostly minor, can be significant or require tube reinsertion. All children receiving jejunal tube feeding should have multidisciplinary team assessment and follow‐up.

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

Abstract: 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.

Cited by 10 publications

References 13 publications

Is Roux‐en‐Y Feeding Jejunostomy a Safe and Effective Operation in Children? A Systematic Review Exploring Outcomes

Is Roux‐en‐Y Feeding Jejunostomy a Safe and Effective Operation in Children? A Systematic Review Exploring Outcomes

Usefulness of Gastrojejunostomy Prior to Fundoplication in Severe Gastro-Esophageal Reflux Complicating Long-Gap Esophageal Atresia Repair: A Preliminary Study

A clinical consensus paper on jejunal tube feeding in children

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