Impact of practice change on intestinal perforation risk for pediatric gastrojejunostomy tube placement

Background: Gastrojejunostomy tubes (GJTs) have been associated with intestinal perforation in children <6 months or <6 kg. This study evaluated the impact of an institutional practice change recommending a new soft tip GJT for children <10 kg. Methods: We performed a single-center review of GJT placements among children <10 kg before (1/1/2010-12/31/2013) and after (7/1/2014-12/31/2016) the practice change. Intestinal perforation, nasojejunal tube (NJT) for >30 days, and GJT replacement were assessed. Results: Sixty GJTs were placed in 35 children (54% male; 17.2 +/- 9.0 months old) after compared to 147 GJTs in 77 children (44% male, p = 0.32; 14.1 +/- 11.8 months, p = 0.08) before the practice change. Use of soft tip GJT was adhered to in 19 placements (32%). There were no intestinal perforations after the practice change (before: 6 (4.1%); p = 0.11). NJT remained >30 days in 15 patients (65%) after the practice change (before: 13 (35%); p = 0.02). Replacement was required for 53% with soft tip GJT and 18% with standard GJT (p = 0.006). Discussion: A reduction in intestinal perforation with an institutional practice change may be explained by fewer GJT placements in high-risk children and longer length of NJT placement. Future protocols may consider age and size restrictions rather than alternative tube types. Type of study: Treatment study. (C) 2019 Elsevier Inc. All rights reserved.