Characterizing Trends in Preoperative Workup and Evaluation for Pediatric Patients Needing Gastrojejunostomy Tube Placement

INTRODUCTION: Gastrojejunostomy tube (GJT) placement in pediatric patients may be indicated for a variety of reasons. Standard pathways exist for preoperative evaluation of patients prior to gastrostomy tube (GT) placement; however, the workup and referral patterns for patients needing GJT are not well described. METHODS: A single-center, retrospective cohort study of pediatric patients who underwent GJT placement between 2014 and 2024 was performed. Included were patients undergoing primary GJT (pGJT) placement and those undergoing staged GJT (sGJT) if the conversion from GT to GJT was within 1 year of index placement. sGJT was further grouped by planned and delayed cohorts, referring to the presence or absence of a plan for short-interval GJT exchange after GT placement. Preoperative workup methods and long-term enteral access outcomes were assessed. RESULTS: There were 90 patients who underwent GJT, including 30 pGJT, 29 planned sGJT, and 31 delayed sGJT. Most were referred by gastroenterology (45.6%), followed by intensivists (21.1%). Upper gastrointestinal fluoroscopic swallow study (60.0%), trial of transpyloric feeds (55.6%), and trial of proton pump inhibitors (41.1%) were frequently obtained preoperatively. The median time from GJT recommendation to surgery was 17.5 days. One year postoperatively, 92.2% of patients had ongoing GJT utilization, compared with 62.2% of patients at most recent follow-up (median: 4.08 years). CONCLUSION: Pediatric GJT placement referral patterns and preoperative workup are heterogeneous. About 40% of patients undergoing GJT placement will have alternative access at the median 4-year follow-up. Standardization of preoperative evaluation and workflow is warranted.