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Roux-en-Y: the route to successful long-term jejunal feeding
  1. C E Paxton1,
  2. P M Gillett1,
  3. A G Wilkinson2,
  4. S McGurk2,
  5. J Livingstone3,
  6. D J Mitchell1,
  7. D A Devadason1,
  8. F D Munro4,
  9. D C Wilson1,5
  1. 1Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh, UK
  2. 2Radiology, Royal Hospital for Sick Children, Edinburgh, UK
  3. 3Dietetics, Royal Hospital for Sick Children, Edinburgh, UK
  4. 4Surgery, Royal Hospital for Sick Children, Edinburgh, UK
  5. 5Child Life and Health, University of Edinburgh, Edinburgh, UK

Abstract

Background and aim Increasing numbers of children with marked upper Gastrointestinal (GI) dysmotility require home enteral tube feeding (HETF). We reviewed the need and outcome of medium/long-term jejunal feeding for problematic gastric HETF.

Methods Retrospective cohort study (database and clinical note review) of use of polyethylene glycol (PEG)-J, transgastric gastrojejunostomy (GJ) tubes and surgical roux-en-Y jejunostomy (ReYJ) in a regional centre serving 1.25 million people. Nasojejunal feeding tubes had only short-term use as a guide to need for jejunal route. All children receiving HETF under 18 years of age during 1 January 2002 to 30 September 2010 were included.

Results 795 children received HETF during the study period. 33 (4%) required medium/long-term jejunal feeding – PEG-J tube in 4, GJ tube in 25, initial surgical ReYJ in 4. 25 children had 71 GJ tubes placed endoscopically/radiologically. The one major complication was death following small bowel intussusception. 43 of 71 tubes were changed for minor complications, including burst balloons in 16 (37%), holes in the Y-port/tube in 10 (23%), and fungal infection in 4 (9%). Proximal tube migration was problematic with both GJ and PEG-J tubes. Of the 29 PEG-J or GJ tube fed children, 7 (24%) returned to gastric feeding, 5 (17%) died from underlying neurodisability and 8 (27%) continue with GJ/PEG-J, 2 awaiting formation of ReYJ. The remaining 9 (31%) needed long-term jejunal feeding and had a surgical ReYJ formed. 13 children had ReYJ formation, at a median (range) age of 3 years 4 months (7 months–17 years 10 months). 11 (85%) of these children have underlying neurodisability, and seven (53%) had previous fundoplication. In terms of outcomes, nine (69%) continue with only minor stoma infection and leakage, two (15%) died from underlying condition, one (8%) moved from region and one (8%) transitioned successfully to adult services.

Conclusions Medium to long-term jejunal feeding via PEG-J or GJ tubes to children with severe GI dysmotility is used for problematic HETF, albeit with time-consuming practical challenges, particularly urgent tube changes. Surgical ReYJ formation provides a secure, relatively complication-free means of providing long-term jejunal feeding to these children.

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