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Impact of practice change on intestinal perforation risk for pediatric gastrojejunostomy tube placement

Calista M Harbaugh1, Christine Wu1, Farokh Demehri2

  • 1Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.

Journal of Pediatric Surgery
|March 2, 2019
PubMed

Insights

A new soft tip gastrojejunostomy tube (GJT) practice for children under 10 kg did not eliminate intestinal perforations but reduced their incidence. Longer nasojejunal tube (NJT) use and fewer GJT placements in high-risk infants may explain the findings.

Area of Science:

  • Pediatric Gastroenterology
  • Surgical Innovation
  • Patient Safety

Background:

  • Gastrojejunostomy tubes (GJTs) are linked to intestinal perforation in young children.
  • Children under 6 months or weighing less than 6 kg are at higher risk.
  • This study examines a new institutional practice for GJT placement in children under 10 kg.

Purpose of the Study:

  • Evaluate the impact of a practice change recommending soft tip GJTs for children under 10 kg.
  • Assess the incidence of intestinal perforation after the practice change.
  • Analyze nasojejunal tube (NJT) duration and GJT replacement rates.

Main Methods:

  • Single-center retrospective review of GJT placements in children <10 kg.
  • Comparison of data before (2010-2013) and after (2014-2016) the practice change.
  • Assessment of intestinal perforation, NJT use >30 days, and GJT replacement.

Main Results:

  • No intestinal perforations occurred post-practice change (vs. 4.1% prior).
  • NJT use >30 days increased significantly (65% vs. 35%).
  • Soft tip GJTs had higher replacement rates (53%) compared to standard GJTs (18%).

Conclusions:

  • The practice change may have reduced intestinal perforations by decreasing GJT use in high-risk infants and prolonging NJT use.
  • Future protocols should consider age and size restrictions for GJT placement.
  • Alternative tube types may not be the sole factor in reducing complications.
Abstract

Keywords:
Gastrojejunostomy tubeIntestinal perforationPediatric surgery

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