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gastrojejunostomy
- Question
- Hello,
my 5 month old daughter has a naso duodenal tube since mid December (at first naso gastric), because she had a low growth, while taking weight, now the doctors discuss about gastrojejunostomy while her weight for height ratio is good, 5.200kg for 58 cm, I would like to know what are the advantages and disadvantages of the tube and the gastrojejunostomy and if there is no alternative less aggressive?
thank you
- Answer
- Hello,
The maintain of a good nutritional status is an essential point for the management of cystic fibrosis, and is included in the current recommendations. After newborn screening we have to assess the nutritional status of screened children and we can propose an early nutritional intervention if necessary.
A poor weight gain leads to evaluate the oral caloric intake, assess the control of exocrine pancreatic insufficiency and possibly look for another cause of malnutrition. Initially, dietetic advices, oral supplementation and optimization of the treatment of pancreatic insufficiency are recommended. On failure, tube feeding is considered. The choice of the route is discussed case by case and depends on the tolerance and the anticipated duration of nutritional support. The nasogastric tube is used for few weeks, but can be maintained over longer periods if it is tolerated. Its advantage is to be less invasive, and the tube can be withdrawn at any time, but it may be poorly tolerated in some cases because of gastro-oesophageal reflux or cough. For a long term nutritional support, or if the nasogastric tube is not tolerated, a gastrostomy insertion is preferred, sometimes with an gastro-oesophageal reflux intervention. The tube is replaced in a second step by a gastrostomy button, which can be removed when it is no longer necessary.
The indication of naso-duodenal tube or jejunostomy remains extremely rare.
Concerning your child, you can discuss with your doctors about the jejunostomy or gastrostomy and ask them the reasons for this choice.
Sincerely
Dr. Michele Gérardin
- 22.03.2012
