Retrograde percutaneous gastrostomy and gastrojejunostomy in 505 children: a 4 1/2-year experience.

Abstract

To evaluate a technique of retrograde insertion of gastrostomy and gastrojejunostomy tubes with radiologic guidance in children. During a 4 1/2-year period, 511 patients underwent attempted insertion of gastrostomy or gastrojejunostomy tubes. Patients' ages ranged from premature to 18.6 years (mean age, 3.8 years), and weight range was 0.8-86.0 kg (mean weight, 12 kg). The charts of 453 patients were reviewed. Placement was unsuccessful in six patients because of colonic interposition (n = 2), microgastria (n = 2), or hepatosplenomegaly (n = 2). Initial placement was a gastrostomy tube in 436 patients and a gastrojejunostomy tube in 69 patients. Sixty-eight gastrostomy tubes were converted to gastrojejunostomy tubes. Early complications (< 30 days) included skin infection (n = 11), stoma irritation (n = 20), and tube dislodgment (n = 6). Late complications included stoma irritation (n = 29), skin infection (n = 23), tube leakage (n = 14), and discomfort during feeding (n = 15). Two complications necessitated surgery: extragastric misplacement and small-bowel transgression. There were no tube-related deaths. Percutaneous retrograde placement of gastrostomy or gastrojejunostomy tubes safely and effectively provides long-term nutrition for children. A team approach is essential to provide service to this cumulative population.