Aim of the Study: To identify major gastrointestinal complications associated with direct jejunal feeding. We hypothesised that jejunal feeding causes life-threatening surgical complications in a minority of patients.
Methods: All patients undergoing jejunal feeding between 01/2008-1/2018 at a paediatric surgical unit were identified retrospectively. Data sought from records included demographics, co-morbidities, indications, feeding strategies, adverse events and follow-up. Major surgical complications were defined by Clavien-Dindo grade ≥IIIb and involving the GI tract (excluding changes of jejunal tube).
Main Results: 197 patients were identified (110 female). Median age at initiation of jejunal feeding months was 45.6 months (158.1 IQR). 122 were neurologically impaired. The most frequent indications were: GORD/gastroparesis (114), prophylaxis/treatment of SMA syndrome (47), congenital anomalies of aero-digestive anatomy (17) and malignancy (7). 125 patients were managed with naso-jejunal feeding alone, 51 by gastro-jejunal tube and 21 via Roux-en-Y jejunostomy. 14 significant gastro-intestinal complications (11 grade >IIIb) were identified amongst 12 patients, of whom 8 required bowel resections and 2 died as a result: non-mechanical bowel ischaemia (7), intussusception (4) and volvulus (3).
Conclusion: This series highlights the major complications of jejunal feeding, including a significant yet under-reported risk of gut compromise. Patients undergoing jejunal feeding had a 6.1% risk of developing major surgical complications (of note, 3.6% developed bowel ischaemia of unknown aetiology). Susceptible children were co-morbid, fragile and neurologically impaired. These findings should influence parental discussions and informed consent before embarking upon jejunal feeding.