Intestinal arginine biosynthesis is crucial for maintaining arginine serum levels in sucklings

Abstract

means for guiding placement of jejunal feeding tubes, its disadvantage has been in the need to transport the patient to the radiology suite, and the extent of radiation exposure. Herein, we describe a method of endoscopically assisted placement of gastrojejunal and nasojejunal feeding tubes in pediatric patients. Patients and Methods: In 1997, a total of 8 patients (7 male; 1 female) with a mean age (range) of 2.4 yrs (1.5-4yrs) required jejunal tube placement. Under general anesthesia, the patient received a single dose of intravenous metoclopramide (0.1mg/Kg). Silk sutures were tied at intervals along the tube, and the tube was advanced and stabilized by using biopsy forceps to grab the sutures. In a step-wise fashion the feeding tube was directed into the pylorns. Once in position, the guide-wire was carefully removed. Results: The indications for jejunal access included: post-operative gastroparesis in 5, and gastroesophageal reflux with oropharyngeal dysmotility in 3 patients. Over the course of one year, 6 patients had a total of 9 gastrojejunal feeding tubes successfully inserted by endoscopy. Three patients had to have their feeding tubes replaced for reasons unrelated to the initial placement after several months of usage. One of the 6 patients had their gastrojejunal feeding tube inserted after an unsuccessful 3 hour attempt by fluoroscopy. Of the remaining 2 patients, nasojejunal feeding tube placement was attempted and successful in one. The failure to insert the tube by endoscopic assistance was attributed to an unrecognized intestinal malrotation. All tubes had their positioning confirmed radiographically, and there were no complications. The overall success for endoscopio jejunal tube placement was 91%. Conclusions: Endoscopically assisted jejunal feeding tube placement is an effective and safe method of establishing a route for enteral nutrition in pediatric patients. Endoscopic placement of jejunal feeding tubes may be used as an initial method of enteric intubation and after an unsuccessful fluoroscopic attempt.