Mortality and morbidity following gastrojejunal feeding tube placement in children and adolescents, does the technique matter? Systematic review

摘要

Abstract Aim This systematic review analysed morbidity and mortality related to the type of technique used to insert gastrojejunal feeding devices in children.Materials and methods The Healthcare Database Advanced Search, Cochrane and Medline databases were used. PRISMA guidelines were followed by two independent reviewers. Non-English language, mixed report of more of one technique and adult population studies were excluded.Results Twenty-three papers were selected; overall, 648 patients underwent jejunal tube insertion: 287 received percutaneous gastrojejunal tube (PEG-J), 140 underwent Laparoscopic-Assisted Jejunostomy (LAJ) and 221 received an open surgical jejunostomy (OSJ). Main indications for jejunal feeds were: neurological impairment (NI), inability in establishing gastric feeds, recurrent aspiration pneumonia, severe Gastroesophageal Reflux Disease, and failed fundoplication. 71.5% of patients experienced minor tube-related complications (misplacement, dislodgment, coiling, and breakage). Major complications were volvulus, bowel obstruction and intussusception accounting, respectively, for 7.2% amongst the PEG-J population, 7.6% amongst the LAJ and 10.7% in between the OSJ population. Mortality related to PEG-J placement was 9.3%, in comparison to the LAJ accounting for 14.6% and 7.8% amongst the OSJ group.Conclusion Mortality and morbidity rate following gastrojejunal feeding tube insertion remains high despite the type of surgical technique used. Careful patient selection, accurate family counselling and multidisciplinary evaluation at decision-making time, is pivotal when considering this enteral feeding route. A clear standardised pathway, also establishing a patient’s inclusion criteria for a more radical approach (such as the Total Esophagogastric Disconnection), should be implemented to improve patient’s quality of life and career’s quality of assistance.