Optimal management of gastrojejunal tube in the ENFit era - Interventions that changed practice.
J Pediatr Surg
; 56(8): 1430-1435, 2021 Aug.
Article
in En
| MEDLINE
| ID: mdl-32921428
ABSTRACT
BACKGROUND:
We experienced a high incidence of jejunal tube (JEJ) displacement in children who underwent percutaneous endoscopic transgastric jejunostomy (PEGJ), ever since the introduction of ENFit connector (2017).METHODS:
Two interventions were introduced in 2018 - fixative suture to PEGJ ENFit connector, and conversion to balloon transgastric-jejunal feeding device (Balloon GJ) whenever possible. Children receiving PEGJ and Balloon GJ in 2.8â¯years were categorized into 3 eras 2016 (pre-ENFit), 2017 (ENFit) and 2018 (interventional), for comparison of complications and sequelae. Kaplan-Meier survival curves with log-rank test (Pâ¯<â¯0.05) were applied.RESULTS:
100 children underwent 323 JEJ insertions - PEGJ (nâ¯=â¯237), Balloon GJ (nâ¯=â¯86). Complications occurred in 188 JEJs (58%), more frequently with PEGJ than Balloon GJ (69% vs. 29%, Pâ¯<â¯0.0005). PEGJ had higher complication/1000-tube-days (6 vs. 0, Pâ¯<â¯0.0005). In 2018, complication rate reduced from 76% to 30% (Pâ¯<â¯0.0005) owing to effectiveness of PEGJ connector suture application (Pâ¯=â¯0.019), and increased utilization of Balloon GJ (16% to 44%, Pâ¯=â¯0.005). Balloon GJ showed better JEJ survival (Pâ¯=â¯0.019), less morbidity (emergency attendance, X-ray) and greater cost-effectiveness than PEGJ.CONCLUSIONS:
Balloon GJ had better overall outcomes than PEGJ. Suture application to connector successfully reduced JEJ internal displacement in PEGJ; however, conversion to Balloon GJ should be strongly considered. LEVEL OF EVIDENCE II.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Jejunostomy
/
Enteral Nutrition
Type of study:
Diagnostic_studies
/
Observational_studies
/
Risk_factors_studies
Limits:
Child
/
Humans
Language:
En
Journal:
J Pediatr Surg
Year:
2021
Type:
Article