CAPS PaperGastrojejunostomy tube complications - A single center experience and systematic review

PurposeGastrojejunostomy tubes (GJTs) enable enteral nutrition in infants/children with feeding intolerance. However, complications may be increased in small infants. We evaluated our single-institution GJT complication rate and systematically reviewed existing literature.MethodsWith REB approval, a retrospective single-institution analysis of GJT placements between 2009 and 2015 was performed. For the systematic review, MOOSE guidelines were followed.ResultsAt our institution, 48 children underwent 154/159 successful insertions primarily for gastroesophageal reflux (n = 27; 55%) and aspiration (n = 11; 23%). Median age at first GJT insertion was 2.2 years (0.2-18). Thirty-five (73%) had an index insertion when ≤ 10 kg. GJTs caused 2 perforations and 1 death. The systematic review assessed 48 articles representing 2726 procedures. Overall perforation rate was estimated as 2.1% (n = 36 studies, 23/1092, 95% CI: 1.0-3.2). Perforation rates in children < 10 kg versus ≥ 10 kg were estimated as 3.1%/procedure (95% CI: 1.1%-5.0%) and 0.1%/procedure (95% CI: 0%-0.3%), respectively. The relative risk of perforation was 9.4 (95% CI: 2.8-31.3). Overall mortality was estimated as 0.9%/patient (n = 39 studies; 95% CI: 0.2-1.6%). Most perforations (19/23; 83%) occurred ≤ 30 days of attempted tube placement.ConclusionGastrojejunostomy tubes are associated with significant complications and frequently require revision/replacement. Insertion in patients < 10 kg is associated with increased perforation risk. Caution is warranted in this subgroup.Level of evidenceLevel II