Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Orlando, October 22-24, 1998
USE OF A GASTRO-JEJUNAL (GJ) FEEDING TUBE PLACED RETROGRADE IN THE ESOPHAGUS FOR DRAINAGE AND DECOMPRESSION IN DISTAL ESOPHAGUS NARROWING.
Management of distal esophageal narrowing secondary to a stricture or "tight" Nissen fundoplication (NF) can pose a challenging problem. In children with neurologic deficits, swallowing dysfunction and esophageal dysmotility can lead to pooling of secretions and aspiration. Esophageal resection, revision of fundoplication or cervical esophagostomy are surgical options of high relative risk. We present 2 cases where a temporizing alternative to surgical intervention was used.
A 5 ½ year old boy with mental retardation and cerebral palsy (MR/CP) secondary to shaken baby syndrome required a NF and gastrostomy for oral-motor dysfunction and GE reflux. Radiographic evaluation showed a dilated distal esophagus with obstruction secondary to the NF. Repeated bougie dilatation did not resolve the obstruction. A 3 ½ year old boy with MR/CP due to perinatal asphyxia was evaluated following revision of a NF and development of a distal esophageal stricture. Both presented with excessive secretions and recurrent aspiration.
A 16 French gastro-jejunal tube (Medical Innovations Corp., UT) was placed through the gastrostomy in the usual manner. Under endoscopic guidance, the jejunal limb was inserted retrograde into the distal esophagus and held in position with a silk string loop attached to its tip. The loop traversed the esophagus, exited the nostril, re-entered the gastrostomy adjacent to the GJ tube, and returned to the jejunal limb tip. The string loop allowed replacement of the jejunal limb in the esophagus without additional endoscopy. Drainage of secretions via the jejunal port was successful, and prevented further aspiration in both patients. Feedings were continued through the gastric port and were well tolerated. In one patient this allowed for adequate nutritional rehabilitation and surgical intervention after 6 months; in the other child the tube has been in place and functioning for 16 months.
Conclusion: Use of a GJ tube with the jejunal limb placed in the esophagus for drainage offers a safe and efficient temporizing option, in cases of esophageal obstruction where a surgical intervention is not immediately indicated.
Esophagus/Stomach© 1998 Lippincott Williams & Wilkins, Inc.