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Images in paediatrics
Knotty issues in postpyloric feeding
  1. Melody Redman1,2,
  2. David Campbell3
  1. 1 Sheffield Children’s NHS Foundation Trust, Sheffield, UK
  2. 2 Department of Oncology & Metabolism, The University of Sheffield, Sheffield, UK
  3. 3 Gastroenterology, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
  1. Correspondence to Dr Melody Redman, Sheffield Children’s Hospital, Sheffield S10 2TN, UK; hy8mgr{at}

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Postpyloric (or jejunal) feeding may be required in children where feeding via gastrostomy is associated with problems of severe gastro-oesophageal reflux leading to faltering growth.1 2

A 2-year-old boy presented with what appeared to be a standard complication of tube blockage, having previously been fed through a 6-French jejunal (J) extension via a 16-French Corflo PEG (PEGJ).  Gastric feeds were commenced during the suspected J tube blockage, and removal of the J tube was attempted. However, as the J tube could not be withdrawn, gastroscopy was performed to explore this further and have his PEG switched to a balloon gastrostomy.

During endoscopy, a true knot was identified in the J tube (figure 1). The J tube was cut and then snared, enabling a standard conversion to balloon gastrostomy to be performed.

Figure 1

Endoscopy image of knot in jejunal tube.

Tube blockage and displacement are the most common associated problems of postpyloric feeding,3 but in this boy’s case, both occurred simultaneously due to a true knot forming in the J tube.

Alternative approaches to the use of a PEGJ tube are direct J tube placement via deep enteroscopy or combined laparoscopy/enteroscopy. Although this prevents the problem of displacement and reduces the risk of blockage (as a 12 to 15-French device can be inserted), the procedure is more invasive and associated with volvulus and internal herniation.4



  • Contributors MR wrote the first draft of the piece. DC performed the procedure, took the image displayed and edited the piece.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.