Abstract
Purpose: To investigate the technical success and safety of a standardised radiological antegrade primary gastrostomy insertion technique in children weighing 5 kg or less. Materials and Methods: A retrospective analysis of all gastrostomies inserted at a single centre over a ten year period between 2003 and 2013 recognized 596 patients undergoing antegrade gastrostomy insertion. Of these 25 patients weighing less than 5 kg were identified. The standardised technique for primary antegrade gastrostomy insertion included the use of a 9Fr Freka gastrostomy, general anaesthesia, biplane fluoroscopy and oral barium prior to the procedure to visualise the colon. Indications, patient characteristics, technical details and complications were recorded prospectively at the time of procedure using a proforma. Results: The mean age of the children weighing less than 5kg was 6 months, range (2-20m). 20 males, 5 females. Patients weighed from 3-5kg (mean 4.5kg). Antegrade gastrostomy insertion was successful in 24/25 patients with no major complications. The unsuccessful procedure was a result of hepatomegaly preventing a safe route for access to the stomach despite distension with air. 3 patients (13%) had minor complications. 2 exit site infections & 1 exit site leakage. All resolved without sequelae with conservative management. No deaths occurred within 30 days of procedure. The results are comparable to those in this centre for children weighing45kg and those in the published literature for gastrostomy insertion in children of all weights and ages. Conclusion: Some endoscopists and surgeons consider the lower limit of body weight to insert gastrostomies to be 10kg but gastrostomies can be inserted safely into smaller children. The results of this study suggest antegrade gastrostomy insertion in infants less tan 5kg is technically feasible and safe with comparable technical success and complication rates to radiological or endoscopic gastrostomy insertion in larger children.
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