婴幼儿内镜下胃空肠吻合术

Endoscopic Gastrojejunostomy in Infants and Children.

作者信息

Elmehdi Sophia, Ley Delphine, Aumar Madeleine, Coopman Stéphanie, Guimber Dominique, Nicolas Audrey, Antoine Matthieu, Turck Dominique, Kyheng Maeva, Gottrand Frédéric

机构信息

Division of Hepatology, Gastroenterology, and Nutrition and the Reference Center for Congenital and Malformative Esophageal Disorders, Department of Pediatrics, University of Lille, CHU Lille, Lille, France; Inserm, U1286, Institute for Translational Research in Inflammation, University of Lille, CHU Lille, Lille, France.

出版信息

J Pediatr. 2022 May;244:115-119.e1. doi: 10.1016/j.jpeds.2022.01.039. Epub 2022 Jan 31.

DOI:10.1016/j.jpeds.2022.01.039

PMID:35108546

Abstract

OBJECTIVE

To evaluate the feasibility of endoscopic gastrojejunal tube (GJT) placement in infants and children.

STUDY DESIGN

All children undergoing endoscopic GJT placement between January 2010 and December 2019 were included in this single-center retrospective study. Difficulties with and failure of GJT placement, complication rates, and device longevity, efficacy, and duration were assessed.

RESULTS

A total of 107 children, median age 10 months (IQR, 5.0-23.0 months) and median weight 6.6 kg (IQR, 5.3-9.5 kg), underwent endoscopic GJT placement using the gastric stoma to introduce the endoscope (one step: n = 36 of 107; 33.6%). Endoscopic placement was successful in 99%. Eight periprocedure complications occurred, including 1 pneumoperitoneum requiring exsufflation, 2 acute pulmonary hypertension episodes leading to death in 1 case, and 5 episodes of bronchospasm. Minor complications were frequent and mostly mechanical (79%), whereas major complications were rare (5.6%): intussusception (n = 4), intestinal perforation (n = 1), and pneumoperitoneum (n = 1). Ten patients died. Of the 97 patients who lived, 85 (87%) were weaned from jejunal feeding at a median of 179 days (IQR, 69-295 days) after initiation. Among them, 30 (35.2%) required fundoplication. Weight for age z-score was significantly higher at weaning.

CONCLUSIONS

GJT placement is feasible in children, even low-weight infants. Complications are frequent but are mostly minor.

摘要

目的

评估内镜下胃空肠造瘘管（GJT）置入术在婴幼儿中的可行性。

研究设计

本单中心回顾性研究纳入了2010年1月至2019年12月期间接受内镜下GJT置入术的所有儿童。评估了GJT置入的困难程度和失败情况、并发症发生率以及装置的使用寿命、疗效和持续时间。

结果

共有107名儿童接受了内镜下GJT置入术，年龄中位数为10个月（四分位间距，5.0 - 23.0个月），体重中位数为6.6千克（四分位间距，5.3 - 9.5千克），采用经胃造口插入内镜的方法（一步法：107例中有36例，占33.6%）。内镜置入成功率为99%。围手术期发生了8例并发症，包括1例需要排气的气腹、2例急性肺动脉高压发作（其中1例死亡）以及5例支气管痉挛发作。轻微并发症很常见，且大多为机械性并发症（79%），而严重并发症很少见（5.6%）：肠套叠（4例）、肠穿孔（1例）和气腹（1例）。10例患者死亡。在97名存活患者中，85例（87%）在开始空肠喂养后的中位数179天（四分位间距，69 - 295天）时停止了空肠喂养。其中，30例（35.2%）需要进行胃底折叠术。断奶时年龄别体重Z评分显著更高。