Endoscopic Gastrojejunostomy in Infants and Children

Abstract

To evaluate the feasibility of endoscopic gastrojejunal tube (GJT) placement in infants and children. All children undergoing endoscopic GJT placement between January 2010 and December 2019 were included in this single-center retrospective study. Difficulties with and failure of GJT placement, complication rates, and device longevity, efficacy, and duration were assessed. A total of 107 children, median age 10months (IQR, 5.0-23.0months) and median weight 6.6kg (IQR, 5.3-9.5kg), underwent endoscopic GJT placement using the gastric stoma to introduce the endoscope (one step: n=36 of 107; 33.6%). Endoscopic placement was successful in 99%. Eight periprocedure complications occurred, including 1 pneumoperitoneum requiring exsufflation, 2 acute pulmonary hypertension episodes leading to death in 1 case, and 5 episodes of bronchospasm. Minor complications were frequent and mostly mechanical (79%), whereas major complications were rare (5.6%): intussusception (n=4), intestinal perforation (n=1), and pneumoperitoneum (n=1). Ten patients died. Of the 97 patients who lived, 85 (87%) were weaned from jejunal feeding at a median of 179days (IQR, 69-295days) after initiation. Among them, 30 (35.2%) required fundoplication. Weight for age z-score was significantly higher at weaning. GJT placement is feasible in children, even low-weight infants. Complications are frequent but are mostly minor.