ABSTRACT
Enteral nutrition can be delivered via an enteral feeding tube, a gastrostomy, or a jejunostomy. In infants, the three main indications are long-term feeding, decompression, or a combination of both modalities. Additional indications include gastric access for esophageal bougienage and administration of medications. A gastrostomy is indicated in esophageal atresia without fistula, when a difficult repair or a stormy course is anticipated, in staging procedures, and when the child has associated anomalies that may interfere with feeding. Congenital duodenal obstruction is usually associated with proximal duodenal dilatation and atony as well as gastric dilatation. The most recent development in pediatric gastrostomy technique was the introduction of pediatric laparoscopically assisted gastrostomy (LAP) in the 1990s, combining the advantages of minimally invasive percutaneous endoscopic gastrostomy (PEG) placement with the safety of the open procedure. In gastrostomy skin-level devices with jejunal extension, dislodgment of the tube from the jejunum back into the stomach can occur, which usually requires radiologic or endoscopic guided repositioning.
