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Image-guided placement of percutaneous de novo low-profile gastrojejunostomy tubes in the pediatric population: a study of feasibility and efficacy

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Abstract

Background

De novo low-profile gastrojejunostomy tubes in pediatric patients offer less external catheter bulk and decreased propensity for dislodgement as children become more mobile. While small cohort studies have evaluated de novo placement of coaxial, adjustable-length, percutaneous gastrojejunostomy (GJ) tubes in children, placement of de novo low-profile GJ tubes in pediatric patients has not been analyzed.

Objective

This study evaluates technical feasibility, safety and clinical efficacy of percutaneous, retrograde placement of de novo low-profile GJ tubes in infants and children.

Materials and methods

Following institutional review board approval, all de novo low-profile GJ tube placements in patients were retrospectively reviewed between May 2014 and May 2017. Technical parameters of fluoroscopy time, tube size, T-fasteners and complications were recorded. Clinical data, including age, indication, weight gain and complications, were analyzed.

Results

Thirty-four de novo low-profile GJ tubes were placed in 34 patients (median age: 9.4 months, range: 2 months-11.8 years; median pre-procedural weight: 7.5 kg, range: 2.9-31.6 kg). Twenty-one 14-Fr and 13 16-Fr GJ tubes were placed with technical success rate of 100%. Average weight gain 3 months’ post procedure was 1.1 kg (range: 0.3-4.8 kg) and average weight percentile for age increase was 9.6% (range: -48.9% to 53.5%). One major complication occurred following balloon inflation within the tract causing pain requiring urgent replacement of the GJ tube. Minor complications occurred in 11 patients (32%): accidental dislodgement (n=9), skin irritation (n=4), tube dysfunction (n=2), leakage (n=2) and tube migration into the esophagus (n=1).

Conclusion

Percutaneous, antegrade, image-guided placement of de novo low-profile GJ tubes is technically feasible, safe and clinically efficacious in appropriately selected pediatric patients.

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Acknowledgements

Portions of this data were presented as an oral abstract presentation at the 2017 Society for Pediatric Radiology annual meeting.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Anne E. Gill, Nicholas Gallagher & C. Matthew Hawkins

  2. Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children’s Healthcare of Atlanta at Egleston, 1364 Clifton Road NE, Suite D112, Atlanta, GA, 30322, USA

    Anne E. Gill & C. Matthew Hawkins

  3. Aerodigestive Center, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Barbara O. McElhanon, Amy R. Painter & Benjamin D. Gold

  4. Department of Pediatrics, Division of Pediatric Gastroenterology, Emory University School of Medicine, Children’s Healthcare of Atlanta at Egleston, Atlanta, GA, USA

    Barbara O. McElhanon

  5. GI Care for Kids, Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA

    Benjamin D. Gold

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  1. Anne E. Gill
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  2. Nicholas Gallagher
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Correspondence to Anne E. Gill.

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Gill, A.E., Gallagher, N., McElhanon, B.O. et al. Image-guided placement of percutaneous de novo low-profile gastrojejunostomy tubes in the pediatric population: a study of feasibility and efficacy. Pediatr Radiol 48, 882–888 (2018). https://doi.org/10.1007/s00247-018-4082-3

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  • DOI: https://doi.org/10.1007/s00247-018-4082-3

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