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The development of pyloric stenosis during transpyloric feedings
L A Latchaw1, N N Jacir, B H Harris
1Division of Pediatric Surgery, Tufts University, Boston.
Insights
Nasojejunal feeding tubes may cause or worsen hypertrophic pyloric stenosis (HPS) in infants with gastroesophageal reflux (GER). Pyloromyotomy alone may allow oral feeding resumption, avoiding more invasive surgeries.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Gastroesophageal reflux (GER) is common in infants.
- Nasogastric and nasojejunal tubes are used for feeding intolerance and aspiration.
Observation:
- Three infants (3-4 months) with GER developed hypertrophic pyloric stenosis (HPS) after nasojejunal tube placement.
- Two infants developed HPS during other surgeries; one was diagnosed via ultrasound after failed nasogastric feeding attempts.
Findings:
- Late presentation of HPS suggests a potential link with transpyloric tube use.
- Transpyloric tubes may induce HPS or worsen existing GER symptoms.
Implications:
- Pyloromyotomy alone may be sufficient for infants needing surgery, enabling oral feeding.
- This approach could reduce perioperative complications associated with fundoplication and gastrostomy tubes.
Abstract:
Three infants, ages 3 to 4 months, had nasojejunal feeding tubes placed for recurrent aspiration and/or feeding intolerance after upper gastrointestinal cineradiographs (ugi) had documented gastroesophageal reflux (GER) with normal pyloric channels and prompt gastric emptying. The tubes had been in place for 3 and 4 weeks, respectively, in the first two infants when classic hypertrophic pyloric stenosis (HPS) was found during fundoplication and gastrostomy tube placement. The last child had a failed attempt at nasogastric tube feedings following 3 months of nasojejunal tube feedings. A repeat ugi suggested HPS, which was confirmed by pyloric ultrasound. This infant underwent pyloromyotomy alone. The late presentation of HPS in these infants suggests that transpyloric tubes might cause the development of HPS and exacerbate the symptoms of preexisting GER. In infants who are expected to eat by mouth, pyloromyotomy alone might allow the reinstitution of orogastric feedings without the perioperative morbidity of fundoplication and gastrostomy tube placement.