{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:05:37Z","timestamp":1788314737463,"version":"build-2803163510"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012940","name":"Universit\u00e4tsklinikum T\u00fcbingen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012940","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fluoroscopically guided jejunal tube placement via percutaneous endoscopic gastrostomy (PEG-J) provides minimally invasive post-pyloric access in children. Limited data exist regarding routine application and procedural risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the safety and technical success of PEG-J in pediatric patients, performed without general anesthesia or sedation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>All pediatric cases of fluoroscopically guided PEG-J procedures performed between 2011 and 2025 were included. Fluoroscopic images were reviewed to determine the final position of the tube tip. Technical success, complications, anatomical variants, and tube patency were assessed. Fluoroscopy time and dose area product (DAP) were documented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 126 PEG-J procedures in 60 children (36 males) were analyzed. The technical success rate was 85% (107\/126) with final tube tip placement in the jejunum in 88 cases (82%) and in the duodenum in 19 cases (18%). Nineteen procedures (15%) were unsuccessful, including six with documented anatomical causes (steep vertical duodenal entry,\n                      <jats:italic>n<\/jats:italic>\n                      =2; malrotation, hiatus hernia, hooked stomach in superior mesenteric artery syndrome, steep take-off of the jejunum with kinking of the tube at the ligament of Treitz,\n                      <jats:italic>n<\/jats:italic>\n                      =1 each) and 13 without documented reasons. The median fluoroscopy time was 5\u00a0min 24\u00a0s (range, 2\u00a0s\u201337\u00a0min), at a frame rate of 0.5 frames per second. The median DAP was 6.1\u00a0cGy\u00b7cm\n                      <jats:sup>2<\/jats:sup>\n                      (range, 0.08\u2013343\u00a0cGy\u00b7cm\n                      <jats:sup>2<\/jats:sup>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fluoroscopically guided PEG-J placement is a safe and effective procedure in pediatric patients, with high technical success and low radiation exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00247-026-06572-8","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T06:26:35Z","timestamp":1773296795000},"page":"1086-1095","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Fluoroscopically guided jejunal tube placement via percutaneous gastrostomy in children: technical success, safety, and procedural parameters"],"prefix":"10.1007","volume":"56","author":[{"given":"Michael","family":"Esser","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Spogis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Hilberath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen F.","family":"Sch\u00e4fer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilias","family":"Tsiflikas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"6572_CR1","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1002\/jpen.2615","volume":"48","author":"KH McGrath","year":"2024","unstructured":"McGrath KH, Collins T, Comerford A et al (2024) A clinical consensus paper on jejunal tube feeding in children. JPEN J Parenter Enteral Nutr 48:337\u2013344","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"6572_CR2","doi-asserted-by":"crossref","unstructured":"Mehta NM, Skillman HE, Irving SY et al (2017) Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr 41:706\u2013742","DOI":"10.1177\/0148607117711387"},{"key":"6572_CR3","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1016\/j.pedn.2021.06.023","volume":"60","author":"H Hawk","year":"2021","unstructured":"Hawk H, Valdivia H (2021) Bedside methods for transpyloric feeding tube insertion in hospitalized children: a systematic review of randomized and non-randomized trials. J Pediatr Nurs 60:238\u2013246","journal-title":"J Pediatr Nurs"},{"key":"6572_CR4","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1177\/0148607115621863","volume":"40","author":"SA McClave","year":"2016","unstructured":"McClave SA, Taylor BE, Martindale RG et al (2016) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 40:159\u2013211","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"6572_CR5","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1097\/MPG.0000000000002379","volume":"69","author":"IJ Broekaert","year":"2019","unstructured":"Broekaert IJ, Falconer J, Bronsky J et al (2019) The use of jejunal tube feeding in children: a position paper by the gastroenterology and nutrition committees of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition 2019. J Pediatr Gastroenterol Nutr 69:239\u2013258","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"6572_CR6","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/j.amjsurg.2003.09.005","volume":"186","author":"JM Nicholas","year":"2003","unstructured":"Nicholas JM, Cornelius MW, Tchorz KM et al (2003) A two institution experience with 226 endoscopically placed jejunal feeding tubes in critically ill surgical patients. Am J Surg 186:583\u2013590","journal-title":"Am J Surg"},{"key":"6572_CR7","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1097\/MPG.0000000000001408","volume":"64","author":"M Thomson","year":"2017","unstructured":"Thomson M, Tringali A, Dumonceau JM et al (2017) Paediatric gastrointestinal endoscopy: European Society for Paediatric Gastroenterology Hepatology and Nutrition and European Society of Gastrointestinal Endoscopy Guidelines. J Pediatr Gastroenterol Nutr 64:133\u2013153","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"6572_CR8","doi-asserted-by":"publisher","first-page":"2312","DOI":"10.1001\/jama.2016.6967","volume":"315","author":"LS Sun","year":"2016","unstructured":"Sun LS, Li G, Miller TL et al (2016) Association between a single general anesthesia exposure before age 36 months and neurocognitive outcomes in later childhood. JAMA 315:2312\u20132320","journal-title":"JAMA"},{"key":"6572_CR9","doi-asserted-by":"publisher","first-page":"e324","DOI":"10.1097\/PCC.0000000000002663","volume":"1","author":"I Osawa","year":"2021","unstructured":"Osawa I, Tsuboi N, Nozawa H et al. (2021) Ultrasound-guided postpyloric feeding tube placement in critically ill pediatric patients. Pediatr Crit Care Med 1:e324\u2013e328","journal-title":"Pediatr Crit Care Med"},{"key":"6572_CR10","doi-asserted-by":"publisher","first-page":"E488","DOI":"10.1055\/a-1774-4736","volume":"10","author":"SS Deliwala","year":"2022","unstructured":"Deliwala SS, Chandan S, Kumar A et al (2022) Direct percutaneous endoscopic jejunostomy (DPEJ) and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) technical success and outcomes: systematic review and meta-analysis. Endosc Int Open 10:E488\u2013E520","journal-title":"Endosc Int Open"},{"key":"6572_CR11","doi-asserted-by":"publisher","first-page":"488","DOI":"10.5152\/dir.2015.14524","volume":"21","author":"A Uflacker","year":"2015","unstructured":"Uflacker A, Qiao Y, Easley G et al. (2015) Fluoroscopy-guided jejunal extension tube placement through existing gastrostomy tubes: analysis of 391 procedures. Diagn Interv Radiol 21:488\u2013493","journal-title":"Diagn Interv Radiol"},{"key":"6572_CR12","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1016\/j.jvir.2010.04.003","volume":"21","author":"CY Kim","year":"2010","unstructured":"Kim CY, Patel MB, Miller MJ Jr et al. (2010) Gastrostomy-to-gastrojejunostomy tube conversion: impact of the method of original gastrostomy tube placement. J Vasc Interv Radiol 21:1031\u20131037","journal-title":"J Vasc Interv Radiol"},{"key":"6572_CR13","doi-asserted-by":"publisher","first-page":"119","DOI":"10.4103\/0189-6725.160353","volume":"12","author":"R Karabulut","year":"2015","unstructured":"Karabulut R, Turkyilmaz Z, Sonmez K et al (2015) A very feasible alternative in patients with feeding difficulties from gastrostomy: jejunal tube advanced through the gastrostomy. Afr J Paediatr Surg 12:119\u2013121","journal-title":"Afr J Paediatr Surg"},{"key":"6572_CR14","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1542\/peds.109.1.45","volume":"109","author":"CL Ogden","year":"2002","unstructured":"Ogden CL, Kuczmarski RJ, Flegal KM et al (2002) Centers for disease control and prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 109:45\u201360","journal-title":"Pediatrics"},{"key":"6572_CR15","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1007\/s00117-010-2066-x","volume":"50","author":"R Veit","year":"2010","unstructured":"Veit R, Guggenberger R, Nosske D, Brix G (2010) Diagnostische Referenzwerte f\u00fcr R\u00f6ntgenuntersuchungen: Aktualisierung 2010 [Diagnostic reference levels for X-ray examinations: update 2010]. Radiologe 50:907\u2013912.","journal-title":"Radiologe"},{"key":"6572_CR16","doi-asserted-by":"publisher","first-page":"4233","DOI":"10.1007\/s00464-021-08757-8","volume":"36","author":"Y Hasan","year":"2022","unstructured":"Hasan Y, Ali A, Sayed AE, Levin A et al (2022) Direct endoscopic placement of percutaneous endoscopic gastrostomies with jejunal extension tubes (PEG-J) using ultra-thin endoscopes - long-term outcomes from a U.S. tertiary referral center. Surg Endosc 36:4233\u20134238","journal-title":"Surg Endosc"},{"key":"6572_CR17","doi-asserted-by":"publisher","first-page":"882","DOI":"10.1007\/s00247-018-4082-3","volume":"48","author":"AE Gill","year":"2018","unstructured":"Gill AE, Gallagher N, McElhanon BO et al. (2018) Image- guided placement of percutaneous de novo low-profile gastrojejunostomy tubes inthe pediatric population: a study of feasibility and efficacy. Pediatr Radiol 48:882\u2013888","journal-title":"Pediatr Radiol"},{"key":"6572_CR18","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1097\/MPG.0b013e31824d970f","volume":"54","author":"L Michaud","year":"2012","unstructured":"Michaud L, Robert-Dehault A, Coopman S et al. (2012) One-step percutaneous gastrojejunostomy in early infancy. J Pediatr Gastroenterol Nutr 54:820\u2013821","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"6572_CR19","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1148\/radiology.190.1.8259389","volume":"190","author":"RS Pobiel","year":"1994","unstructured":"Pobiel RS, Bisset GS 3rd, Pobiel MS (1994) Nasojejunal feeding tube placement in children: four-year cumulative experience. Radiology 190:127\u2013129","journal-title":"Radiology"},{"key":"6572_CR20","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1007\/s00247-009-1362-y","volume":"39","author":"L Vitta","year":"2009","unstructured":"Vitta L, Raghavan A, Morrell R, Sprigg A (2009) Fluoroscopy-guided insertion of nasojejunal tubes in children - setting local diagnostic reference levels. Pediatr Radiol 39:1203\u20131208","journal-title":"Pediatr Radiol"}],"container-title":["Pediatric Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00247-026-06572-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00247-026-06572-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00247-026-06572-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T05:19:17Z","timestamp":1777612757000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00247-026-06572-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":20,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["6572"],"URL":"https:\/\/doi.org\/10.1007\/s00247-026-06572-8","relation":{},"ISSN":["1432-1998"],"issn-type":[{"value":"1432-1998","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]},"assertion":[{"value":"24 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 March 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}