Feeding Jejunostomy: Is It a Safe Route in Pediatric Patients? Single Institution Experience
Francesco Fascetti-Leon1,2, Hisham El Agami2, Dalia Gobbi3
1Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padova, Italy.
Insights
Feeding Jejunostomy (FJ) in children often leads to complications like tube dislodgement and requires readmissions. The high risk of severe complications necessitates careful consideration before opting for this enteral feeding method.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Nutritional Support
Background:
- Feeding Jejunostomy (FJ) is indicated in children when gastrostomy is not feasible or gastroesophageal reflux surgery fails.
- Unsafe swallow is a primary concern necessitating enteral feeding solutions.
Purpose of the Study:
- To quantify the incidence and types of complications associated with surgically inserted Feeding Jejunostomy in pediatric patients.
- To evaluate the long-term outcomes and risks of FJ in children.
Main Methods:
- Retrospective review of 19 pediatric patients who underwent surgical FJ insertion between 2009 and 2013.
- Data collection included medical records, operative notes, and radiology databases, focusing on complications and outcomes.
Main Results:
- No intraoperative complications were observed. Postoperative complications occurred in 7 of 19 patients.
- Tube dislodgement/blockage was frequent (0.48 times/month/patient), leading to radiation exposure for reinsertion.
- Two patients discontinued FJ due to poor tolerance; three were weaned off.
Conclusions:
- Feeding Jejunostomy in children can lead to significant complications, including frequent tube issues and the need for radiological interventions.
- The potential for severe complications and readmissions associated with FJ warrants careful consideration in clinical decision-making.
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.
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