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

Abstract

BackgroundGastrojejunostomy tubes (GJTs) have been associated with intestinal perforation in children <6 months or <6 kg. This study evaluated the impact of an institutional practice change recommending a new soft tip GJT for children <10 kg. MethodsWe performed a single-center review of GJT placements among children <10 kg before (1/1/2010–12/31/2013) and after (7/1/2014–12/31/2016) the practice change. Intestinal perforation, nasojejunal tube (NJT) for >30 days, and GJT replacement were assessed. ResultsSixty GJTs were placed in 35 children (54% male; 17.2±9.0 months old) after compared to 147 GJTs in 77 children (44% male, p=0.32; 14.1±11.8 months, p=0.08) before the practice change. Use of soft tip GJT was adhered to in 19 placements (32%). There were no intestinal perforations after the practice change (before: 6 (4.1%); p=0.11). NJT remained >30 days in 15 patients (65%) after the practice change (before: 13 (35%); p=0.02). Replacement was required for 53% with soft tip GJT and 18% with standard GJT (p=0.006). DiscussionA reduction in intestinal perforation with an institutional practice change may be explained by fewer GJT placements in high-risk children and longer length of NJT placement. Future protocols may consider age and size restrictions rather than alternative tube types. Type of studyTreatment study. Level of evidenceLevel III.