Conversion to Gastrojejunostomy Tubes in Developmentally Disabled Children Intolerant to Gastrostomy Tube Feeding

Area of Science:

• Pediatric Gastroenterology
• Clinical Nutrition
• Medical Device Technology

Background:

• Developmentally disabled children often require enteral feeding support due to difficulties with oral intake.
• Gastrostomy tubes (GTs) are commonly used, but conversion to gastrojejunostomy tubes (GJTs) may be necessary for improved outcomes.
• Evaluating the transition from GTs to GJTs is crucial for optimizing nutritional support in this population.

Purpose of the Study:

• To assess the safety and clinical outcomes of converting surgically placed gastrostomy tubes (GTs) to gastrojejunostomy tubes (GJTs).
• To evaluate the impact of GJT conversion on the growth of developmentally disabled children.
• To identify complications and tube maintenance issues associated with gastrojejunostomy tubes.

Main Methods:

• Retrospective evaluation of 44 developmentally disabled children who underwent GT to GJT conversion.
• Analysis of clinical outcomes, including growth parameters (weight-for-age z-scores), complications, and tube maintenance issues (TMIs).
• Long-term follow-up data collection over 31,378 device-days.

Main Results:

• Conversion to GJTs was associated with sustained growth, evidenced by increased weight-for-age z-scores over time.
• A high rate of minor complications (70.5%) and TMIs (93.2%) was observed.
• Three major complications (aspiration pneumonia) occurred (6.8%); higher TMI rates correlated with lower z-scores (P=0.06).
• GJTs were removed in 13.6% of patients due to adequate oral intake.

Conclusions:

• Conversion from GTs to GJTs is a safe and viable strategy for promoting growth in developmentally disabled children.
• Close monitoring for tube maintenance issues is essential, as frequent TMIs may impede growth.
• Further research into optimizing GJT management is warranted to improve clinical outcomes.