Novel Feeding Method Allows Enteral Nutrition in Infants and Children Undergoing Advanced Endoscopic Esophageal Therapy

Abstract

Abstract Objectives To describe a novel method of feeding infants and children undergoing treatment for esophageal perforation. Endoscopic vacuum sponge (EVAC) therapy is a modified wound vacuum device that is inserted via gastrostomy site into the esophageal lumen in order to treat perforation. EVAC generally requires gastrostomy tube removal and loss of access for enteral nutrition (EN), obligating parenteral nutrition (PN) for the duration of therapy. In these patients, EN is preferable to PN as their distal GI tracts are functional. Our team devised a novel feeding tube device to allow for post-pyloric EN during EVAC therapy. Our hypothesis was that the feeding tube modification to the EVAC could safely and feasibly reduce PN use, avoid central line placement, and increase EN delivery. Methods Retrospective chart review of medical records in our cohort of pediatric patients who received EN during EVAC therapy for esophageal perforation between August 2018 and November 2019. Reason for EVAC therapy, delivery and timeline of prescribed EN, and complications were recorded. Results During this study period, 10 cases received EN support during EVAC therapy. Six (60%) underwent EVAC placement due to esophageal perforation encountered during planned endoscopy. All six avoided central line placement and none received PN. Four (40%) received EVAC therapy after identification of unexpected post-surgical perforation; all required a central line and two received PN initially until the feeding tube device was placed during EVAC exchange. Of the full cohort of 10 cases, 7 (70%) reached prescribed EN rate by POD#2 and received a mean of 72% prescribed volume. Two (20%) did not reach prescribed EN rate before EVAC removal. Complications included tube migration into the stomach (1 case, 10%) and excessive leaking of gastric contents (1 case, 10%). Conclusions Our novel EVAC and post-pyloric feeding tube device allows for safe and feasible provision of EN and has become the new standard for our infants and children undergoing EVAC therapy for esophageal perforation. Increased ability to provide EN may reduce infection risk, lower hospital costs, and support normal gut structure and function. This device shows promise in reducing the need for PN and central line as well as increasing EN delivery. A larger study with historical controls is planned. Funding Sources None.