Gastrojejunostomy Tube Placement in Pediatric Patients: A Comparison of Staged Versus Primary Techniques and...

Pediatric gastrojejunostomy tube (GJT) placement can be done staged (sGJT), with gastrostomy tube (GT) placement and later exchange for GJT, or in a single procedural setting, referred to as primary GJT (pGJT). Here, we compare procedural metrics and outcomes for sGJT versus pGJT placement.

A retrospective cohort study of pediatric patients undergoing GJT placement between 2014 and 2024 categorized patients as pGJT, planned sGJT (GT with documented plan for GJT conversion) or delayed GJT (GT with gastric feed trials and later conversion to GJT within 12 months). Generalized linear regressions assessed associations between GJT placement modality and outcomes of interest.

There were 90 patients who underwent GJT placement (30 pGJT, 29 planned sGJT, 31 delayed sGJT). pGJT had 76% longer procedure time than delayed sGJT (P < .001). Delayed sGJT had 6.8 and 8.0 times greater radiation exposure than planned sGJT and pGJT, respectively (P = .009). Intraoperative visceral perforation occurred in 3 out of 90 patients (pGJT n = 2, planned sGJT n = 1, P = .422). Hospital length of stay (LOS) was at least 1.5 times greater in patients undergoing sGJT placement (incidence rate ratio = 1.54 for delayed and 2.28 for planned, both P < .001). Rate of jejunal limb retrograde migration was higher in patients undergoing pGJT. Overall, 77.8% of patients undergoing GJT experienced any complication within 1 year, but only 1.1% of patients experienced a major complication requiring reoperation.

Pediatric pGJT is associated with longer procedure time, but shorter hospital LOS and reduced radiation exposure when compared with patients undergoing planned or delayed sGJT placement. Complication rates after GJT are high regardless of placement modality.