The hierarchy of copper status in paediatric enteral tube feeding: A comparative retrospective cohort study of jejunal and gastric feeding: GI Signals

Nutrition retrospective · n=220 · Jul 20, 2026 · Clin Nutrition · IF 6.6

The hierarchy of copper status in paediatric enteral tube feeding: A comparative retrospective cohort study of jejunal and gastric feeding.

Epidemiologypediatricmicronutrient deficiencyenteral nutrition

Clinical takeawayMeasure serum copper annually in pediatric patients on jejunal tube feeding. If depletion is identified, initiate copper sulphate supplementation via gastric or jejunal tube to restore normal levels and prevent cytopenia. Consider more frequent monitoring in patients with neurodisability or complex gastrointestinal comorbidities, as these groups have significantly higher depletion rates (up to 25%).

What it foundPediatric jejunal tube feeding patients have a 13% cumulative copper depletion rate, 6.27 times higher than simple gastric feeding, with more severe deficiency (median 8.7 μmol/L) and increased cytopenia risk; all patients receiving copper sulphate supplementation normalized their levels.

ContextThis 21-year cohort study confirms and extends existing pediatric guidelines recommending annual copper screening in jejunally-fed patients. It demonstrates a clear risk hierarchy: complex gastric feeding (25% depletion) > jejunal feeding (13%) >> simple gastric feeding (2.5%), supporting the hypothesis that bypassing normal upper gastrointestinal absorption mechanisms is the primary driver of copper depletion.

Emergingsuggested applicable standard· ASGE 2024 (Gastrointest Endosc 2025;101:25-35) / ESGE 2021 (Endoscopy 2021;53:178-195)

Decision at stakewhether to implement annual copper screening in children on jejunal tube feeding

… Device selection among PEG, PEG-J, DPEJ, surgical gastrostomy, and parenteral nutrition remains multidisciplinary, and a goals-of-care discussion before placement, including avoiding routine PEG in advanced dementia in favor of careful hand feeding (AGA 2020 / Choosing Wisely), is unchanged.

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

PEG remains the standard for durable enteral access in patients unable to swallow safely or meet nutritional needs orally, placed by the pull (Gauderer-Ponsky) technique, and ASGE 2024 now suggests PEG over IR-guided gastrostomy for initial placement in normal foregut anatomy. A single prophylactic IV dose of a beta-lactam antibiotic (e.g., cefazolin) is given before placement. Post-procedure bowel rest is no longer recommended: feeding may start within 3-4 hours of uncomplicated placement (ESGE 2021, strong/high-quality; ASGE 2024, strong/moderate), medications may be given immediately, and routine gastric residual volume checks are not indicated. Buried bumper prophylaxis is daily site care with DAILY inward tube mobilization and a loose external bumper kept 1-2 cm from the abdominal wall (ESGE 2021), not weekly rotation. Antiplatelet agents, including dual antiplatelet therapy, need not be routinely withheld for PEG; anticoagulant management is individualized by multidisciplinary discussion of bleeding versus thrombotic risk. In malignant dysphagia, either transoral pull PEG or direct (introducer) PEG is acceptable with counseling about implantation metastasis and periodic site examination. Device selection among PEG, PEG-J, DPEJ, surgical gastrostomy, and parenteral nutrition remains multidisciplinary, and a goals-of-care discussion before placement, including avoiding routine PEG in advanced dementia in favor of careful hand feeding (AGA 2020 / Choosing Wisely), is unchanged.

ASGE 2024 (Gastrointest Endosc 2025;101:25-35) / ESGE 2021 (Endoscopy 2021;53:178-195) · reviewed 2026-07-19 ↗

Cairney DG … Merrick V · Clinical Nutrition · IF 6.6 · PubMed ↗Permalink