12 What is the Evidence? Gastrojejunal (GJ) Tubes for Children: A Scoping Review
Authors: Lee Esther , Bandara Nilanga Aki , Zhou Xuan Randy , Booy Emily 
Published: September 2023

Abstract

Background
Feeding tubes have become an important part of care for children with various health conditions. Using gastrojejunal (GJ) tubes is increasingly common in children who do not tolerate gastric feeding. There are some recent articles that show GJ tubes are safe for children. Despite the increasing number of children who require these feeding tubes and their associated safety profile, health care professionals do not have adequate education on GJ tube use. This can impact the care received by children who require GJ tubes. Further, it is necessary to consider the experiences of caregivers who support these children.

Objectives
There appears to be a paucity of synthesized data on GJ tube use in paediatrics in the academic literature. Therefore, the aim of this review is to bring forward literature reflecting clinical indications for placement, standardized pathways, quality improvement initiatives, and the experiences of patients, families, and caregivers. This will help us better understand the relationship that GJ tubes have with various stakeholders involved in healthcare.

Design/Methods
A scoping review was undertaken on Embase, Medline and Web of Science. The search parameters were built with the assistance of a subject expert librarian. All articles were uploaded and screened using the Covidence research management software. Following automatic duplicate removal on Covidence, a total of 2,154 articles of interest were found. Following abstract and title screening, 142 articles were assessed in the full-text review stage. Finally, after full-text review, 97 articles were included for data extraction. Refer to Figure 1.
One member of our research team is the parent of a child who used a GJ tube, whose role is to review our search criteria as well as results.

Results
There are several clinical indicators for GJ tube placement, such as neurological, gastrointestinal, respiratory, cardiovascular, and surgical-related indications. Also, GJ tubes are more often placed as an alternative to fundoplication. Often a GJ tube is placed subsequent to a gastric tube for patients who were unable to tolerate gastric feedings.
In considering standardized pathways, a variety of initiatives have been initiated and assessed with the goal of increasing the efficiency of tube placements. Various benefits have been documented as a result of the implementation of these standardized pathways, including reduced health visits to the emergency department and shorter postoperative stays in the hospital.
There have been various quality improvement initiatives also, ranging from surgical innovations regarding tube placement, tube complication reduction initiatives, and certain considerations for specific populations who may have additional support needs.
For patients, there were several documented benefits for children, such as improved weight. There were also increases in satisfaction of the child and parent/caregiver. Regarding placement, it was found that parents often experienced stress and sometimes felt uninformed about the tube placement process.

Conclusion
This scoping review has highlighted a variety of domains that children experience in relation to GJ tubes. This information can support the stakeholders involved in the healthcare process. Moving forward, additional reviews that focus on specific domains are necessary to appraise the quality of the data and highlight future directions.