Roux-en-Y: the route to successful long-term jejunal feeding

Paxton, C. E.; Gillett, Peter M.; Wilkinson, A G; McGurk, Siobhan; Livingstone, Jennifer; Mitchell, DH; Devadason, David; Munro, Fraser D.; Wilson, Dorian

doi:10.1136/adc.2011.212563.29

Cited by 1 publication

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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 Unpublished data were also attained.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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