Evaluation of Durability of Gastrojejunostomy Tubes and Assessment of Radiation Exposure During Gastrojejunostomy Tube Placements in Pediatric Patients

Purpose: Current understanding of long-term outcomes and optimal interval for gastrojejunostomy tube (GJT) exchanges remains unclear in the literature. Before July 2014, our institutional practice was to exchange GJT as needed. After July 2014, routine exchanges at 6 months intervals were employed. We aim to describe our institutional experience of GJT exchanges prior to and following institution of routine exchanges, specifically assessing clinical durability and evaluating the radiation exposure in pediatric patients.

Material and Methods: A single-center retrospective review of 76 pediatric patients who received a GJT with subsequent exchanges from 2012 to 2016 was completed. Demographic, clinical, and procedural information was obtained from the electronic medical record.

Results: A total of 477 GJT exchanges were analyzed. The average “dwell-time” of the GJT was 84 days. After institution of routine exchanges, only 20% of patients had their GJT “routinely” exchanged, while 80% of tubes malfunctioned or became dislodged prior to the scheduled exchange. The fluoroscopy time and radiation for routine exchanges were 0.24 minutes and 0.56 mGy, while exchanges performed for tube malfunction yielded a fluoroscopy time of 2.25 minutes and a radiation dose of 3.18 mGy (p < 0.001 and p = 0.005, respectively). There was a significant difference in both fluoroscopy time and radiation dose between adult and pediatric trained interventional radiologists (p < 0.0001).

Conclusion: To our knowledge, there are no prior publications that specifically assess durability of GJT. We demonstrate that GJT can be utilized for long-term enteral access, but do require maintenance and replacement. Having a pediatric-trained interventional radiologist perform these procedures can greatly mitigate the radiation exposure.