725 - Variability in Gastrojejunostomy Tube Usage in Infants and Children

Poster Number: 725
Publication Number: 725.105

Oliver S. Zhao, Vanderbilt University School of Medicine, Nashville, TN, United States; Maren Shipe, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Melissa Danko, Vanderbilt University Medical Center, Nashville, TN, United States; Jamie Robinson, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States

Background: Gastrojejunostomy tube (GJT) placement is a commonly performed procedure for enteral access in children with chronic gastric feeding intolerance. While GJT placement is overall considered a low-risk procedure, studies have demonstrated its association with significant morbidity and mortality secondary to a spectrum of potential complications.

Objective: Prior studies have suggested against the use of GJTs in infants under 10 kg; however, greater knowledge regarding technical considerations to avoid complications and updated GJT devices for infants have since been developed. We aim to better characterize the usage of GJTs in children and investigate risk factors for post-operative complications. 

Design/Methods: Retrospective review of all children who underwent GJT placement using fluoroscopic guidance within the Pediatric Health Information Systems Database from 2012-2022 was performed. Demographic data and outcomes were measured. Categorical outcomes were compared using chi-square analysis and continuous variables with t-tests. Multivariable logistic regression was used to determine associations with complications. 

Results: 2,701 children underwent GJT placement during the study period. 382 (14.1%) of children were under 1 year of age. Of the 35 institutions were GJTs were placed in infants, 243 (63.6%) were at one of 7 institutions. The remaining 28 institutions placed less than 10 GJTs during the 11-year study period. 849 of the total cohort of 2,701 children had a complication (31.4%), and 130 of those were in infants (34.0% of all GJTs in infants). In multivariable regression, the priority of admission was the most significant risk factor for complications in all children and infants alone (OR 0.78 and OR 0.67, respectively) with 579 (68.1%) of all children and 105 (80.8%) of infants with complications being urgent or emergent. In multivariable regression, age was not associated with increased complications. 

Conclusion(s):

There is wide variability in the usage of GJTs for enteral access in infants and children with chronic feeding difficulties. While prior literature is suggestive of increased complications in younger children, we found high complication rates in all children with no increased rates in infants. The most significant risk factor for complications following GJT placement is the need for surgery during an urgent or emergent admission. In infants, GJT placement is associated with similar complication rates as older children and should be considered when other feeding modalities are unsuccessful.