What Is the Correct Way to Manage Children Requiring Gastrostomy? Single Center Experience

Carmine Noviello,Giovanni Cobellis,Edoardo Bindi,Alfonso Papparella,Stefano Nobile,Mercedes Romano

doi:10.3390/gastroent12030030

Abstract

Children with complex medical issues often present different comorbidities that cause feeding difficulties. Gastrostomy is often helpful, and should be performed when nutritional supplementation is necessary for longer than 6 weeks. Recently, different techniques have been used for gastrostomy in children. The authors report on their experiences regarding the diagnostic and therapeutic management of children requiring gastrostomy. All patients managed in the last 10 years were reviewed, retrospectively. Everyone underwent investigation to exclude gastroesophageal reflux disease (GERD). A total of 148 patients: 111 cases (75%) were neurologically impaired patients, 18 (12%) had complex heart disease, 10 (6%) had metabolic diseases, 4 (3%) had fibrosis cystic, 4 (3%) had muscle disease, and one had chromosomopathy. After investigation, 49 patients had GERD. PEG was performed in 101 cases (68%), laparo-assisted gastrostomy was performed in 44 cases (29.7%), open gastrostomy was performed in three cases. At follow-up, all patients reported weight gain, but 13 cases had major complications. Currently, the surgeon has the possibility of choosing between several safe techniques for gastrostomy. In our experience, PEG is the most useful technique for patients without GERD, while a laparo-assisted technique is better for patients who require laparoscopic fundoplication.

Highlights

Children with complex diseases often present different comorbidities, and feeding difficulty is one of these
The indication for gastrostomy was a dietary difficulty in all cases: had poor nutritional status; four cases needed the ketogenic diet for the treatment of epilepsy (Table 1)
This prompts a preliminary study before placing a gastrostomy so that gastroesophageal reflux can be corrected at the same time as the gastrostomy, a recent meta-analysis shows that positioning the gastrostomy alone exposes the patient to fewer postoperative complications [10]

Summary

Introduction

Children with complex diseases often present different comorbidities, and feeding difficulty is one of these. Syndromic patients, or children with severe heart diseases can suffer from oromotor dysfunction, eating disorders, dysphagia, malabsorption, or maldigestion [1]. In the long-term, these conditions can lead to severe malnutrition, heavily impacting the general status of these patients (i.e., severe growth problems). When nutritional supplementation is necessary, for longer than weeks, access techniques for long-term enteral nutrition, such as a gastrostomy, should be performed [2]. The gastrostomy positioning technique has undergone several changes, from the open to the laparoscopic technique. The endoscopic technique: percutaneous endoscopic gastrostomy (PEG) was introduced in the 1980s [3]

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Discussion

Conclusion