Abstract
Both gastrostomy and jejunostomy are basic surgical procedures for children of all ages. A gastrostomy is considered a physiologic and usually well-tolerated access, working for continuous and bolus feedings as well as gastric venting and drug application. Nowadays, minimally invasive or endoscopic methods are considered the gold standard, whereas the classic open technique is applied only in very small patients or patients with special comorbidities.
Jejunostomies are implemented in children in need of long-term enteral access, who are unable to get a gastrostomy. They are less frequently used because they are considered less physiologic, more difficult to place and maintain, and more prone to complications.
All children with enterostomies must be carefully followed to prevent short- and long-term catheter-related complications. These patients benefit from an interdisciplinary follow-up team consisting of a pediatrician, pediatric surgeon, nutritionist, and primary nurse to assure optimal functionality and minimal morbidity.
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References
Abdelhadi RA, Rahe K, Lyman B (2016) Pediatric enteral access device management. Nutr Clin Pract 31(6):748–761. https://doi.org/10.1177/0884533616670640
Akay B, Capizzani TR, Lee AM, Drongowski RA, Geiger JD, Hirschl RB, Mychaliska GB (2010) Gastrostomy tube placement in infants and children: is there a preferred technique? J Pediatr Surg 45(6):1147–1152. https://doi.org/10.1016/j.jpedsurg.2010.02.079
Antonoff MB, Hess DJ, Saltzman DA, Acton RD (2009) Modified approach to laparoscopic gastrostomy tube placement minimizes complications. Pediatr Surg Int 25(4):349–353. https://doi.org/10.1007/s00383-009-2340-z
Backman T, Sjövie H, Kullendorff C-M, Arnbjörnsson E (2010) Continuous double U-stitch gastrostomy in children. Eur J Pediatr Surg 20(1):14–17. https://doi.org/10.1055/s-0029-1238316
Baker L, Emil S, Baird R (2013) A comparison of techniques for laparoscopic gastrostomy placement in children. J Surg Res 184(1):392–396. https://doi.org/10.1016/j.jss.2013.05.067
Baker L, Beres AL, Baird R (2015) A systematic review and meta-analysis of gastrostomy insertion techniques in children. J Pediatr Surg 50(5):718–725. https://doi.org/10.1016/j.jpedsurg.2015.02.021
Broekaert IJ, Falconer J, Bronsky J, Gottrand F, Dall’Oglio L, Goto E et al (2019) The use of jejunal tube feeding in children: a position paper by the Gastroenterology and Nutrition Committees of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition 2019. J Pediatr Gastroenterol Nutr 69(2):239–258. https://doi.org/10.1097/MPG.0000000000002379
Campwala I, Perrone E, Yanni G, Shah M, Gollin G (2015) Complications of gastrojejunal feeding tubes in children. J Surg Res 199(1):67–71. https://doi.org/10.1016/j.jss.2015.06.058
Chatwin M, Bush A, Macrae DJ, Clarke SA, Simonds AK (2013) Risk management protocol for gastrostomy and jejunostomy insertion in ventilator dependent infants. Neuromuscul Disord 23(4):289–297. https://doi.org/10.1016/j.nmd.2013.01.006
Corkins MR, Fitzgerald JF, Gupta SK (2010) Feeding after percutaneous endoscopic gastrostomy in children: early feeding trial. J Pediatr Gastroenterol Nutr 50(6):625–627. https://doi.org/10.1097/MPG.0b013e3181bab33d
Cortez AR, Warren PW, Goddard GR, Jenkins TM, Sauser JA, Gerrein BT, Rymeski BA (2020) Primary placement of a low-profile gastrostomy button is safe and associated with improved outcomes in children. J Surg Res 249:156–162. https://doi.org/10.1016/j.jss.2019.11.027
Demehri FR, Simha S, Herrman E, Jarboe MD, Geiger JD, Teitelbaum DH, Gadepalli SK (2016) Analysis of risk factors contributing to morbidity from gastrojejunostomy feeding tubes in children. J Pediatr Surg 51(6):1005–1009. https://doi.org/10.1016/j.jpedsurg.2016.02.072
Farrelly JS, Stitelman DH (2016) Complications in pediatric enteral and vascular access. Semin Pediatr Surg 25(6):371–379. https://doi.org/10.1053/j.sempedsurg.2016.10.006
Fascetti-Leon F, El Agami H, Gobbi D, Clarke S, Haddad M, Choudhry M (2018) Feeding jejunostomy: is it a safe route in pediatric patients? Single institution experience. Eur J Pediatr Surg 28(3):293–296. https://doi.org/10.1055/s-0037-1603526
Fujiogi M, Tanaka Y, Amano H, Deie K, Suzuki K, Kawashima H et al (2018) A new laparoscopic triangle fixation technique for gastrostomy: a safe and effective procedure for reduction of the wound infection rate. Nagoya J Med Sci 80(4):497–503. https://doi.org/10.18999/nagjms.80.4.497
Gauderer MWL (2006) Gastrostomy. In: Spitz L, Coran AG (eds) Operative pediatric surgery, 6th edn. Hodder Arnold, London, pp 330–355
Gauderer MWL (2009) Gastrostomy and jejunostomy. In: Puri P, Höllwarth ME (eds) Pediatric surgery: diagnosis and management, 1st edn. Springer, Berlin, pp 369–381
Gauderer MWL (2012) Stomas of the small and large intestine. In: Coran AG, Adzick NS, Krummel TM, Laberge J-M, Shamberger RC, Caldamone AA (eds) Pediatric surgery. Elsevier Saunders
Gauderer MWL, Stellato TA (1986) Gastrostomies: evolution, techniques, indications, and complications. Curr Probl Surg 23(9):661–719. https://doi.org/10.1016/0011-3840(86)90020-1
Gauderer MWL, Zimmer J (2017) Access for enteral nutrition. In: Puri P (ed) Newborn surgery, 4th edn. CRC Press, Boca Raton
Gauderer MWL, Ponsky JL, Izant RJ (1980) Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 15(6):872–875. https://doi.org/10.1016/S0022-3468(80)80296-X
Goldin AB, Heiss KF, Hall M, Rothstein DH, Minneci PC, Blakely ML et al (2016) Emergency department visits and readmissions among children after gastrostomy tube placement. J Pediatr 174:139–145.e2. https://doi.org/10.1016/j.jpeds.2016.03.032
Hassan SF, Pimpalwar AP (2011) Modified laparoendoscopic gastrostomy tube (LEGT) placement. Pediatr Surg Int 27(11):1249–1254. https://doi.org/10.1007/s00383-011-2977-2
Hendrickson RJ, Poola AS, Sujka JA, Weaver KL, Rentea RM, St Peter SD, Oyetunji TA (2018) Feeding advancement and simultaneous transition to discharge (FASTDischarge) after laparoscopic gastrostomy. J Pediatr Surg 53(11):2326–2330. https://doi.org/10.1016/j.jpedsurg.2018.04.035
Heuschkel RB, Gottrand F, Devarajan K, Poole H, Callan J, Dias JA et al (2015) ESPGHAN position paper on management of percutaneous endoscopic gastrostomy in children and adolescents. J Pediatr Gastroenterol Nutr 60(1):131–141. https://doi.org/10.1097/MPG.0000000000000501
Jensen AR, Renaud E, Drucker NA, Staszak J, Senay A, Umesh V et al (2018) Why wait: early enteral feeding after pediatric gastrostomy tube placement. J Pediatr Surg 53(4):656–660. https://doi.org/10.1016/j.jpedsurg.2017.06.015
Kaya M, Sancar S, Ozcakir E (2018) A new method for laparoscopic stamm gastrostomy. J Laparoendosc Adv Surg Tech A 28(1):111–115. https://doi.org/10.1089/lap.2017.0447
Landisch RM, Colwell RC, Densmore JC (2016) Infant gastrostomy outcomes: the cost of complications. J Pediatr Surg 51(12):1976–1982. https://doi.org/10.1016/j.jpedsurg.2016.09.025
Liu R, Jiwane A, Varjavandi A, Kennedy A, Henry G, Dilley A et al (2013) Comparison of percutaneous endoscopic, laparoscopic and open gastrostomy insertion in children. Pediatr Surg Int 29(6):613–621. https://doi.org/10.1007/s00383-013-3313-9
Livingston MH, Pepe D, Jones S, Bütter A, Merritt NH (2015) Laparoscopic-assisted percutaneous endoscopic gastrostomy: insertion of a skin-level device using a tear-away sheath. Can J Surg 58(4):264–268. https://doi.org/10.1503/cjs.014814
Lotti M, Carrara G, Lovece A, Giulii CM (2020) Laparoscopic tubularized continent gastrostomy: an alternative to tube gastrostomies. Updat Surg 72(3):901–905. https://doi.org/10.1007/s13304-020-00795-6
Mason CA, Skarda DE, Bucher BT (2018) Outcomes after laparoscopic gastrostomy suture techniques in children. J Surg Res 232:26–32. https://doi.org/10.1016/j.jss.2018.05.022
McCann C, Cullis PS, McCabe AJ, Munro FD (2019) Major complications of jejunal feeding in children. J Pediatr Surg 54(2):258–262. https://doi.org/10.1016/j.jpedsurg.2018.10.078
Merli L, Marco EA d, Fedele C, Mason EJ, Taddei A, Paradiso FV et al (2016) Gastrostomy placement in children: percutaneous endoscopic gastrostomy or laparoscopic gastrostomy? Surg Laparosc Endosc Percutan Tech 26(5):381–384. https://doi.org/10.1097/SLE.0000000000000310
Novotny NM, Vegeler RC, Breckler FD, Rescorla FJ (2009) Percutaneous endoscopic gastrostomy buttons in children: superior to tubes. J Pediatr Surg 44(6):1193–1196. https://doi.org/10.1016/j.jpedsurg.2009.02.024
Pang T, Sesia SB, Holland-Cunz S, Mayr J (2017) Replaceable jejunal feeding tubes in severely ill children. Gastroenterol Res Pract 2017:2090795. https://doi.org/10.1155/2017/2090795
Petrosyan M, Khalafallah AM, Franklin AL, Doan T, Kane TD (2016) Laparoscopic gastrostomy is superior to percutaneous endoscopic gastrostomy tube placement in children less than 5 years of age. J Laparoendosc Adv Surg Tech A 26(7):570–573. https://doi.org/10.1089/lap.2016.0099
Sandberg F, Viktorsdóttir MB, Salö M, Stenström P, Arnbjörnsson E (2018) Comparison of major complications in children after laparoscopy-assisted gastrostomy and percutaneous endoscopic gastrostomy placement: a meta-analysis. Pediatr Surg Int 34(12):1321–1327. https://doi.org/10.1007/s00383-018-4358-6
Sayadi Shahraki M, Berjis N, Bighamian A, Mahmoudieh M, Shahabi Shahmiri S, Sheikhbahaei E (2020) Minimally invasive technique for gastrostomy tube insertion: a novel laparoscopic approach. Asian J Endosc Surg 13(4):610–613. https://doi.org/10.1111/ases.12780
Simons M, Bulat R (2021) Chapter 29 – Enteric tube placement for gastroparesis: gastrostomy, gastrojejunostomy and jejunostomy. In: RW MC, Parkman HP (eds) Gastroparesis. Academic Press, pp 397–411. https://doi.org/10.1016/B978-0-12-818586-5.00029-6
Singh RR, Eaton S, Roebuck DJ, Barnacle AM, Chippington S, Cross KMK et al (2018) Surgical jejunostomy and radiological gastro-jejunostomy tube feeding in children: risks, benefits and nutritional outcomes. Pediatr Surg Int 34(9):951–956. https://doi.org/10.1007/s00383-018-4303-8
Smitherman S, Pimpalwar A (2009) Laparoendoscopic gastrostomy tube placement: our all-in-one technique. J Laparoendosc Adv Surg Tech A 19(1):119–123. https://doi.org/10.1089/lap.2007.0210
Sulkowski JP, Roo AC d, Nielsen J, Ambeba E, Cooper JN, Hogan MJ et al (2016) A comparison of pediatric gastrostomy tube placement techniques. Pediatr Surg Int 32(3):269–275. https://doi.org/10.1007/s00383-015-3847-0
Sutherland C, Carr B, Biddle KZ, Jarboe M, Gadepalli SK (2017) Pediatric gastrostomy tubes and techniques: making safer and cleaner choices. J Surg Res 220:88–93. https://doi.org/10.1016/j.jss.2017.06.075
Thaker S, Misra MV (2019) A comparison of laparoscopic gastrostomy tubes and percutaneous endoscopic gastrostomy in infants: results from a single institution. J Pediatr Surg 54(11):2453–2456. https://doi.org/10.1016/j.jpedsurg.2019.06.024
Vasseur Maurer S, Reinberg O (2015) Laparoscopic technique to perform a true Stamm gastrostomy in children. J Pediatr Surg 50(10):1797–1800. https://doi.org/10.1016/j.jpedsurg.2015.06.010
Vermilyea S, Goh VL (2016) Enteral feedings in children: sorting out tubes, buttons, and formulas. Nutr Clin Pract 31(1):59–67. https://doi.org/10.1177/0884533615604806
Villalona GA, Mckee MA, Diefenbach KA (2011) Modified laparoscopic gastrostomy technique reduces gastrostomy tract dehiscence. J Laparoendosc Adv Surg Tech A 21(4):355–359. https://doi.org/10.1089/lap.2010.0201
Volpe A, Malakounides G (2018) Feeding tubes in children. Curr Opin Pediatr 30(5):665–670. https://doi.org/10.1097/MOP.0000000000000666
Watanabe J, Kotani K (2020) Early versus delayed feeding after percutaneous endoscopic gastrostomy placement in children: a meta-analysis. Children 7:124. https://doi.org/10.3390/children7090124
Wiernicka A, Matuszczyk M, Szlagatys-Sidorkiewicz A, Landowski P, Toporowska-Kowalska E, Gębora-Kowalska B et al (2019) Tolerability and safety of early enteral nutrition in children after percutaneous endoscopic gastrostomy placement: a multicentre randomised controlled trial. Clin Nutr 38(4):1544–1548. https://doi.org/10.1016/j.clnu.2018.08.018
Williams K, Baumann L, Abdullah F, Hendrickson RJ, Oyetunji TA (2019) Elective laparoscopic gastrostomy in children: potential for an enhanced recovery protocol. Pediatr Surg Int 35(6):643–647. https://doi.org/10.1007/s00383-019-04472-7
Wilson L, Oliva-Hemker M (2001) Percutaneous endoscopic gastrostomy in small medically complex infants. Endoscopy 33(5):433–436. https://doi.org/10.1055/s-2001-14268
Zimmer J, Gauderer MWL (2020) Access for enteral nutrition. In: Puri P (ed) Encyclopedia of pediatric surgery. Springer, Berlin. https://doi.org/10.1007/978-3-642-38482-0_19-1
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Brendel, J., Gauderer, M.W.L. (2023). Gastrostomy and Jejunostomy. In: Puri, P., Höllwarth, M.E. (eds) Pediatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-81488-5_61
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