Related Experiment Video
Updated: Dec 9, 2025
Intestinal Epithelial Regeneration in Response to Ionizing Irradiation
Published on: July 27, 2022
Enough is enough: Radiation doses in children with gastrojejunal tubes
Niti Shahi1, Ryan Phillips1, Shannon N Acker1
1Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
Insights
Frequent gastrojejunal (GJ) tube replacements in children can lead to significant cumulative radiation exposure and high costs. Consider surgical jejunostomy for patients exceeding radiation thresholds to mitigate risks.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
- Medical Device Management
Background:
- Pediatric patients with feeding intolerance often require gastrojejunal (GJ) tubes for postpyloric feeding.
- While initial placement involves low radiation, frequent replacements pose an often-overlooked cumulative radiation risk.
- The financial and health implications of repeated GJ tube procedures warrant investigation.
Purpose of the Study:
- To determine the frequency and cost of pediatric GJ tube replacements.
- To quantify radiation doses from GJ tube placement and replacements.
- To assess the rate of conversion to surgical jejunostomies.
Main Methods:
- Retrospective review of pediatric patients undergoing GJ tube procedures (2010-2018).
- Evaluation of initial placement and replacement costs, procedure frequency, and cumulative radiation doses (mGy).
- Data collected from Interventional Radiology, surgery, and gastroenterology departments.
Main Results:
- 203 patients identified; 150 had radiation data. Median of five GJ tube replacements per patient (range: 0-88).
- Median cumulative radiation dose was 6.0 mGy; 9% exceeded 50 mGy from replacements alone.
- Median replacement cost was $1170, totaling over $1.4 million for dislodged tubes during the study period.
Conclusions:
- Average radiation dose per GJ replacement was 3.50 mGy.
- Consider surgical jejunostomy for patients exceeding 50 mGy cumulative radiation, or specific high-dose replacement patterns.
- This highlights the need to weigh radiation exposure and cost against alternative long-term feeding solutions.
Introduction:
Many children with gastric feeding intolerance require postpyloric tube feeding via a gastrojejunal (GJ) tube. Placement or positioning of these tubes is typically a procedure with a low dose of radiation. Although the risk of developing cancer from radiation exposure owing to computed tomography scans is well-documented in children, the risk of cumulative radiation exposure owing to frequent GJ tube replacement often goes unnoticed in the clinical decision-making process. We sought to define the frequency and cost of GJ tube replacement, quantify the radiation doses associated with the initial placement and replacements, and assess the number of conversions to surgical jejunostomies.
Methods:
All pediatric patients who underwent GJ tube placement or replacement by Interventional Radiology (IR), surgery, and gastroenterology between 2010 and 2018 at a single center were reviewed. We evaluated the total cost of the initial placement and replacement of each GJ tube, the total number of replacements, and the cumulative radiation dose (mGy).
Results:
We identified 203 patients who underwent GJ tube placement and/or replacement, of which 150 had radiation data available. Patients underwent a median of five GJ tube replacement procedures, and there was a wide range in the number of replacements per patient, from zero to 88. Patients were exposed to a median cumulative dose of 6.0 mGy (IQR: 2.2, 22.6). Nine percent of patients with available radiation data were exposed to more than 50 mGy, solely from GJ tube replacements. The median cost per replacement was $1170. The sum of the cost of the replacements for dislodged GJs translated to more than $1.4 million during the study period.
Conclusions:
Overall, the average dose per GJ replacement was 3.50 mGy among all patients with available data. Nine percent of patients (14/150) were exposed to greater than 50 mGy cumulative radiation solely from GJ replacements. Patients who receive more than 50 mGy of cumulative radiation dose, who undergo seven GJ tube replacements in one year, or two consecutive GJ tube replacement procedures with radiation doses exceeding 10 mGy (per replacement) should be considered for a surgical jejunostomy.
Level Of Evidence:
IV TYPE OF STUDY: Treatment study.
Related Concept Videos
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
02:59Biological Effects of Radiation
01:29Drug Dosing: Infants and Children
01:05Absorption of Radiation
01:13Radiological Investigation III: Pulmonary Angiogram and PET Scan
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...