Should Gastrojejunostomy Tubes be Changed Every Three Months? A Two-Year Single Institution Retrospective Analysis of Unscheduled Gastrojejunostomy Tube Changes
AffiliationThe University of Arizona College of Medicine - Phoenix
MetadataShow full item record
PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractBackground: To date there is a significant lack of data on the best practices for maintaining gastrojejunostomy tubes (GJ) in pediatric medicine. Purpose: To determine the average longevity of a GJ tube, the reasons for GJ tube change, and the cumulative radiation dose associated changes. Methods: A single institution retrospective chart review of patient data over a two-year period was performed utilizing an MPower database to identify GJ exchanges/replacements. An exchange was defined as a correctly positioned GJ tube and replacement as a mispositioned GJ tube. The patients’ age, fluoroscopy time, time between change, brand of tube, and reason for replacement were recorded and statistical analysis performed. Results: 143 patients were identified, with a total of 534 GJ changes performed. There were 331 exchanges and 203 replacements. The average length between procedures was 140.6 days with an average fluoroscopy time of 1.76 minutes. Cumulative fluoroscopy time annually was significantly higher if a patient needed a replacement (11.4 minutes) versus an exchange (0.92 minutes). G-JET® brand was more likely to malfunction (8.9%) due to a valve issues compared to MIC-KEY® (3.3%), p = 0.03. MIC-KEY® was three times more likely (OR = 3.01) to be replaced for malposition or leaking, p= 0.009. Conclusion: Current guidelines set by manufacturers can be extended from 3 months to nearly 5 months. Tube replacements result in significantly higher radiation exposure compared to exchanges. Further studies are needed to ascertain whether scheduling has a lower rate of exchanges vs not scheduling.