Purpose or Case Report: Gastrojejunostomy (GJ) tubes are a convenient way to provide nutrition to children with complex medical issues. A known complication is development of a small bowel intussusception. We perceived an increase in GJ tube intussusceptions (GJIs) at our quaternary care hospital. The purpose of our study was to identify cases of GJI, risk factors for development, and determine if there was a safety device issue.
Methods & Materials: After Institutional Review Board approval, cases of GJI were identified over a 24 month period (2014-2016). Patient records were reviewed for pertinent clinical information and information related to the GJ-tube including type of tube, presenting symptoms of GJI, and management of the GJI.
Results: During the study period, a total of 123 patients had at least one GJ-tube tube placed or replaced. Of those patients, 17 developed a GJI. The median patient age was 3.3 years (range 0.4-15.1 years). All patients had complex medical histories (Table 1). The last tube manipulation prior to intussusception occurred a median of 38 days prior to GJI, with 8 occurring <30 days after manipulation, and 5 occurring between 30-60 days after manipulation. Imaging was obtained after suspicious signs and symptoms (Table 2). Abdominal ultrasound was ordered and diagnosed 10 cases (56%), CT 6 cases, and MRI 2 cases. There was a wide variety of tubes seen in patients with GJI (Table 3).
The initial management plan included GJ-tube removal in 11 patients, removal and replacement of a different tube in 3 patients, and monitoring in 4 patients, 2 of which were asymptomatic. A total of 9 patients either kept or required their GJ-tube be replaced, with replacement an average of 10.8 days after GJI. In 50% of patients, gastrostomy tube feeds were tolerated and replacement of the GJ-tube was not required.
Conclusions: Given intussusceptions were observed across various GJ tubes, a specific device safety issue was not identified. We found a 14% rate of intussusception in our complex patient population, which is similar to previously published GJI rates. An unexpected finding was that 50% of patients went on to tolerate gastrostomy tube feeds, not requiring replacement of their GJ tube. A positive outcome of our research project has been an increased awareness of this complication throughout the hospital, and after education an increased utilization of abdominal ultrasound in patients with GJ-tubes and any suspicious symptoms.