Gastrostomy Button Research Articles

Developmental Pharmacokinetics and Safety of Ibuprofen and Its Enantiomers in the Conventional Pig as Potential Pediatric Animal Model

Pediatric drug development, especially in disease areas that only affect children, can be stimulated by using juvenile animal models not only for general safety studies, but also to gain knowledge on the pharmacokinetic and pharmacodynamic properties of the drug. Recently, the conventional growing piglet has been suggested as juvenile animal model. However, more studies with different classes of drugs are warranted to make a thorough evaluation whether the juvenile pig might be a suitable preclinical animal model. Ibuprofen is one of the most widely used non-steroidal anti-inflammatory drugs in human. The present study determined the PK parameters, gastro-intestinal and renal safety of 5 mg/kg BW ibuprofen after single intravenous, single oral and multiple oral administration to each time eight pigs (four males, four females) aging 1, 4, 8 weeks and 6–7 months. Oral administration was performed via a gastrostomy button. A jugular catheter was used for intravenous administration and blood sampling. To assess NSAID induced renal toxicity, renal function was evaluated using iohexol and p-aminohippuric acid as markers for glomerular filtration rate and renal plasma flow, respectively. After the trial, necropsy and histology was performed to evaluate macroscopic and microscopic gastro-intestinal as well as renal lesions. Both enantiomers, R-ibuprofen and S-ibuprofen, were determined in plasma using an in-house developed and validated UHPLC-MS/MS method. Pharmacokinetic parameters were estimated using compartmental analysis. Clearance and volume of distribution of total ibuprofen and both enantiomers increased with age as was observed in human. The rate of stereochemical conversion decreased with age. Multiple oral dosing decreased the absolute oral bioavailability and maximum plasma concentration of R-ibuprofen and food consumption did not influence drug absorption. Based on the limited available pediatric literature, the current study might suggest the conventional pig as suitable animal model to evaluate NSAIDs for pediatric use.

Gastrostomy tube displacement following spinal surgery

Abstract We present the case of a 12 year-old female with spastic quadriplegia whose gastrostomy tube button was inadvertently displaced resulting in the intraperitoneal administration of formula with subsequent severe peritonitis, septic shock and death within 48 h. The operating room findings included 700 cc of formula in the peritoneal cavity and the partial separation of the gastric wall at the gastrostomy site from the abdominal wall. The patient had undergone spinal corrective surgery 5 months prior and her gastrostomy tube has been replaced per routine by the caregiver the day prior to the onset of symptoms. We hypothesize that the postsurgical positional changes resulting from her spinal corrective surgery changed her stomach relationship to the abdominal wall placing the gastrostomy button on tension and resulting in the erosion of the balloon through the stomach wall with disruption of the gastrostomy tract. We recommend that meticulous monitoring, changing button to a regular gastrostomy tube and potential repositioning of the gastrostomy tube site be considered after spinal corrective surgery in such patients.

Perceptions of Gastrostomy Buttons Among Caregivers of Children With Special Health Care Needs

IntroductionChildren with special health care needs (CSHCN) have chronic conditions that generally are classified as developmental disabilities. Children with developmental disabilities are at high risk of malnutrition. Gastrostomy buttons are frequently used to provide enteral nutrition for children with developmental disabilities. ObjectiveThis study aimed to understand caregivers’ perceptions regarding gastrostomy button placement for CSHCN. MethodsCaregivers (N = 257) were recruited from CSHCN peer support groups to complete an online survey regarding perceptions of gastrostomy button placement. Kolmogorov–Smirnov testing found that results were not normally distributed. Nonparametric testing with Spearman rank correlation was used to determine the relationship between Overall Satisfaction With Choice and all other perception variables. ResultsThe findings suggested overall satisfaction and willingness to accept gastrostomy button placement earlier. ConclusionGastrostomy button placement has diverse effects for children with developmental disabilities and their families. Health care professionals must be knowledgeable about the positive and negative outcomes to effectively educate families as they consider gastrostomy placement.

Gastrostomy Tubes: Care and Feeding.

Parents often bring their children to the emergency department for adverse events with their child's gastrostomy tube or button. This review will discuss the possible complications and the methods to handle them.

A case could be excised through fistula to gastrostomy button in stomach.

A case could be excised through fistula to gastrostomy button in stomach.

Unusual Case of Acute Pancreatitis Resulting from a Foley Catheter

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a relatively safe procedure for long-term enteral feeding, with procedure-related mortality rates as low as 0 to 2%. One of the complications after PEG tube placement is inadvertent tube removal, which occurs in 1.6 to 4.4% of cases. A Foley catheter (FC) is often placed temporarily by the emergency department or nursing facility to maintain gastrostomy tract patency. We report a case of acute pancreatitis in a patient with a FC balloon that migrated into the jejunum. Case presentation: A 59-year-old woman presented from a nursing home with acute-onset abdominal pain and vomiting. Her medical history was significant for traumatic brain injury, with resulting dysphagia leading to PEG tube placement. Several weeks prior to presentation, the gastrostomy tube was replaced by a FC due to inadvertent dislodgement. Physical exam at presentation revealed epigastric abdominal tenderness. The gastrostomy stoma showed no sign of erythema or infection, but the length of FC outside the patient's body was only approximately 10 cm. Laboratory studies showed elevated serum lipase of 5923 Units/L and a clinical diagnosis of pancreatitis was made. An upper abdominal ultrasound showed a normal gallbladder without cholelithiasis or bile duct dilation. Serum triglyceride level was normal. Abdominal CT with IV contrast revealed acute uncomplicated pancreatitis. The FC tip and a dilated balloon were seen in the proximal jejunum. Since no alternative cause of pancreatitis was found, it was postulated that due to FC's lack of an internal retention mechanism, distal migration of the balloon caused obstruction at the ampulla of Vater, resulting in acute pancreatitis. The balloon was deflated and the FC was repositioned so that the internal balloon was relocated to the stomach. When the patient clinically improved, an upper endoscopy was performed and the FC was replaced by a low profile gastrostomy button. Discussion: Acute pancreatitis is a rare complication after a FC is used to replace a standard gastrostomy tube. A FC should be substituted only on a temporary basis and active medical intervention should be sought to place a new gastrostomy tube. While the FC is in place, care should be taken to periodically inspect the length of tubing external to the body. In patients with temporary gastrostomy tubes, migrated catheters should be considered in the differential of patients presenting with acute pancreatitis.

Gastrostomy Complications in Pediatric Cancer Patients: A Retrospective Single‐Institution Review

Complications in pediatric cancer patients after a gastrostomy (GT) placement have not been widely investigated. We aimed to evaluate the complication rate and nature of complications in this specific population. Medical records of pediatric cancer patients having a GT placed at our institution from 1998 to 2013 were retrospectively reviewed. Variables analyzed included gender, age, diagnosis, surgical procedure, GT device, duration of GT usage, absolute neutrophil count (ANC) level at surgery, and complications. One hundred seventy-one patients (92 males, 79 females), median age of 6 years (range, 0.2-21), who underwent 181 procedures (110 open, 59 endoscopic, and 12 laparoscopic) were identified. Diagnosis included central nervous system tumor (n = 101), solid tumor (n = 45), and leukemia/lymphoma (n = 25). A GT tube was used in 139 procedures and a GT button in 42. Median ANC level at procedure was 3,300/mm(3) (range, 0-38,988). Median duration of GT usage was 8 months (range, 0.2-142). One hundred seventy-seven complications occurred in 106 patients (61.9%) and were categorized as perioperative (<1 month after surgery, 20.3%) and late (>1 month after surgery, 79.7%). Major complications included 42 (23.7%) GT site infections and four (2.2%) intrabdominal complications. The most common minor complication was granulation tissue (28.8%). Younger age at procedure was associated with complications (P = 0.048) and an open technique was associated with GT site infection (P = 0.003). No statistical significance was observed between complications and gender, diagnosis, GT device, duration of GT usage, and ANC at procedure. Younger patients were more likely to have complications, and GT site infections were more common after open GT procedures.

The “omega” jejunostomy tube: A preferred alternative for postpyloric feeding access

AimWe present our technique for construction of the “Omega Jejunostomy” (OJ), a novel method of postpyloric feeding using a pouched-jejunal loop capable of accommodating a balloon gastrostomy button. We describe potential indications for the procedure and outcomes in a complex patient population. Materials and methodsWe retrospectively reviewed records of patients who underwent an OJ at our institution between 2005 and 2014. Primary outcomes include operating time, length of hospital stay, time to feeding goals, and postoperative complications. ResultsWe identified 12 children (6 males) with multiple comorbidities who underwent OJ procedures. The median age at surgery was 11years (range 3months–23years). Eleven patients had failed previous alternative feeding access or antireflux procedures. All patients eventually reached their feeding goals. Eight were at goal feeds in <10days. Two achieved goal feeds <1month, one <4months, and one within 7months. There was one OJ failure because of fistula formation requiring surgical revision, and one child was treated successfully but died of unrelated causes. Four children eventually transitioned to PO or G-tube feeds, and six were tolerating feeds via OJ at last follow-up (8–74months). ConclusionsOJ provides a durable alternative to gastrojejunostomy tube for patients who are poor candidates for or have failed Nissen fundoplication. It is technically easier to perform than a gastroesophageal disconnect procedure, has minimal surgical comorbidities, and can provide durable feeding access and achievement of goal feeds in a complex and refractory patient subset.

Endoscopic button gastrostomy: Comparing a sutured endoscopic approach to the current techniques

PurposeButton gastrostomy is the preferred feeding device in children and can be placed open or laparoscopically (LBG). Alternatively, a percutaneous endoscopic gastrostomy (PEG) can be placed initially and exchanged for a button. Endoscopic-assisted button gastrostomy (EBG) combines both techniques, using only one incision and suturing the stomach to the abdominal wall. The long-term outcomes and potential costs for EBG were compared to other techniques. MethodsChildren undergoing EBG, LBG, and PEG (2010–2013) were compared. Patient demographics, procedure duration/complications, and clinic and emergency room (ER) visits for an eight-week follow-up period were compared. ResultsPatient demographics were similar (32 patients/group). Mean procedure time (min) for EBG was 38±9, compared to 58±20 for LBG and 31±10 for PEG (p<0.0001). The most common complications were granulation tissue and infection with a trend toward fewer infections in EBG group. Average number of ER visits was similar, but PEG group had fewer clinic visits. 97% of PEG patients had subsequent visits for exchange to button gastrostomy. ConclusionsEBG is safe and comparable to LBG and PEG in terms of complications. It has a shorter procedure time than LBG and does not require laparoscopy, device exchange, or subsequent fluoroscopic confirmation, potentially reducing costs.

De novo radiologic placement of button gastrostomy: a feasibility study in children with cancer.

Primary placement of percutaneous radiologic button gastrostomy has been successfully performed in adults but research is lacking as to its success in children during cancer treatment. To assess the safety and effectiveness of such treatment at a single center. We conducted a 3-year retrospective feasibility study reporting on placement procedure, feeding plan, acute complications and effectiveness of this technique based on the evolution of the weight and weight-to-height during a period of 3 months. Eleven gastrostomies were performed in 11 children and young adults (3-20 years old) during oncological treatment. No major complications occurred. Two patients experienced minor side effects -- local leakage and granulation tissue formation -- both easily treated. In all cases, enteral feeding started within 24 h following the button placement. The patients were able to go home within 72 h. After 1 month, 64% (7/11) had gained weight, 18% (2/11) had maintained weight and 9% (1/11) had lost weight. After 3 months, 73% (8/11) had gained weight and 9% (1/11) had lost weight. The procedure and devices were well tolerated and mostly effective in our cohort.

216 Gastrostomy button primary placement using an endoscopically guided gastropexy technique in cystic fibrosis: A single centre's early experience

Background and Objective Endoscopically guided gastropexy technique (EGGT) is a one-stage procedure that supersedes button gastrostomy insertion following prior tract formation by a percutaneous endoscopic gastrostomy. During EGGT, the button is placed in the centre of three gastropexy sutures. We sought to investigate adult Cystic Fibrosis patients' experience of EGGT for primary placement of gastrostomy buttons. Method Semi-structured interviews were conducted with six patients who underwent button insertion via EGGT. Questions included reasons for choosing a button over alternative feeding tubes, experience post-procedure, impact of a button on health, and benefits and concerns of the EGGT procedure. Time taken to consent to the procedure, post-procedure complications, and change in body mass index (BMI) were established from retrospective record review. Results Prominent themes included patient preference for a button due to its discrete size (3/6) and avoidance of uncomfortable nasogastric tubes (3/6). EGGT was regarded as uncomplicated due its single-procedure nature (4/6). All patients felt that the button positively impacted on their health and stated that they would recommend EGGT. Median time taken to consent to EGGT button placement was 4.5 months. There were no unexpected or severe post-procedure complications. One patient required dilatation of the tract due to weight gain. Median weight gain was 6.7 kg at one year follow-up; median BMI increased from 17.9 kg/m 2 to 20.5 kg/m 2 . Conclusion EGGT button placement was well accepted by our patients. No severe post-procedure complications were noted. Weight gain was achieved by all patients at follow-up.

G214(P) Blended food for enteral feeding via a gastrostomy

<h3></h3> A blended diet for enteral nutrition is defined as home-made everyday food blended to a smooth “single cream” consistency. Currently blended food is not recommended by the British Dietetic Association as a first choice supporting guidance on enteral feeding from N. I. C. E. However in a UK children’s hospice the policy is where possible to replicate the care received at home, respecting parents’ wishes. Therefore guidelines needed to be created for its use in the hospice. Benefits in physical and emotional health needed to be balanced against risks in tube blockage, contamination and digestive upsets. Aim was to gather information and risk assess the processes in order to formulate guidelines on the use of blended food for staff and parents. The process involved searches for information on the internet and liaising with specialist groups of dieticians and tube manufacturers. For the process of syringing/plunging where there is very little information available a visual demonstration was developed using a plastic box and a gastrostomy button. For issues relating to contamination and food hygenine we used exsisting guidance on food preparation. Guidelines were developed and presented to our clinical governance group for consideration and acceptance for use. Working with local dieticians a package of information including all the considerations and risks where developed to give to parents. Blended food is not recommended as a primary choice for enteral feed and may not be supported by all those involved in a childs care such as schools or respite unit. Blended diet is used by 10% of the tube fed children using our service. With careful consideration we have been able to develop practical guidelines that support and replicate care given at home whilst respecting the choices made by all our families on how their children are feed. For the future one UK university has started research to look at the health, social benefits and implications of blended diet. In North America where there are prescription costs and strict insurance schemes many opt for blended food, for others this is simply their preferred method. Here a company has developed a shelf safe product for gastrostomy feeding from “real food” available on Amazon.com

Pneumatosis Intestinalis in a Corticosteroid-Dependent Child

A 12-year-old boy with pseudohypoaldosteronism, chronic lung disease, hypopituitarism, gastrostomy button, and corticosteroid-dependence presented with 1 day of crampy periumbilical and left upper-quadrant abdominal pain that did not radiate. He was afebrile and had no nausea, vomiting, diarrhea, or constipation. The family had not vented the gastrostomy tube, but he had been tolerating feeds well. On arrival, his vital signs demonstrated a temperature of 98.1°F, pulse of 86 beats/min, respiration was 24 breaths/min, blood pressure 112/71 mm Hg, and oxygen saturations of 95% in ambient air.

Early Diagnosis of Colonic Anastomotic Leak With Peritoneal Endoscopy.

Background and Objectives:At present, we do not have a reliable method for the early diagnosis of colorectal anastomotic leakage (AL). We tested peritoneal flexible endoscopy through a port placed in the abdominal wall in the early postoperative course, as a new diagnostic method for detection of this complication and evaluated the suggested method for safety, feasibility, and accuracy.Methods:Ten swine were randomized into 2 groups: group A, colorectal anastomosis without leakage; and group B, colorectal anastomosis with leakage. A button gastrostomy feeding tube was inserted percutaneously into the peritoneal cavity. Colorectal anastomosis (with or without defect) was created 48 hours after the first operation. The swine were examined by peritoneal flexible endoscopy 8 and 24 hours after the colonic operation, by a consultant surgeon who was blinded to both the presence and the allocated location of the of the anastomotic defect.Results:None of the animals showed signs of illness 48 hours after the intraperitoneal gastrostomy tube placement. More than half of the anastomosis circumference was identified in 60 and 10% of the animals at endoscopy 8 and 24 hours, respectively, after the anastomosis was created. Excessive adhesion formation was observed in all animals, irrespective of AL. The sensitivity and specificity of endoscopy in detecting peritonitis 24 hours after AL were both 60%.Conclusions:Peritoneal endoscopy is a safe and simple procedure. Visualization of the peritoneal cavity in the early postoperative course was limited due to adhesion formation. Further studies are needed to clarify the accuracy of the procedure and to address additional methodological concerns.

Information du patient (et de ses proches) avant la réalisation d’une gastrostomie percutanée endoscopique selon la technique « introducer » pour l’administration d’une nutrition entérale

Since its initial description by Gauderer in 1980, the technique of percutaneous endoscopic gastrostomy (PEG) and the tubings used are improved. Kits for PEG placement using the “introducer” method now allow to eliminate the risk of metastatic graft onto the stoma in case of oropharynx or esophagus cancer and to insert gastrostomy button in one step. This document has been developed in order to help practitioners to meet legal requirements to inform the patient before an invasive procedure.

Usefulness of a continuous suction mouthpiece during percutaneous endoscopic gastrostomy: A single-center, prospective, randomized study

No mouthpiece has been designed to control salivary flow during endoscopic procedures. A new continuous suction mouthpiece (CSM) was developed, and its usefulness for percutaneous endoscopic gastrostomy (PEG) was evaluated. Seventy-two patients who were scheduled to undergo PEG or the exchange of a gastrostomy button or tube were assigned to one of two groups: the group using the CSM and the group using the conventional mouthpiece. Aspiration pneumonia, procedure duration, extent of salivary flow, frequency of saliva suction, and number of choking episodes during the procedures were evaluated and compared between the two groups. The same number of patients was randomly allocated to each group. There were no significant differences between the two groups in sex, age, procedure type, duration of procedure,depth of sedation, and indication for the procedure. The grade of salivary flow was significantly lower in patients with the CSM than in patients with the conventional mouthpiece (P < 0.001). Significantly fewer suctions and choking episodes were observed in patients with the CSM than in patients with the conventional mouthpiece (P = 0.013, and P = 0.015, respectively). Aspiration pneumonia and other significant adverse events were not observed in either group. CSM reduced the number of episodes associated with salivary flow in PEG-related procedures. The device is expected to reduce complications such as aspiration not only in PEG but in other upper endoscopic procedures.

Insertion of Balloon Retained Gastrostomy Buttons: A 5-Year Retrospective Review of 260 Patients

Radiologically inserted gastrostomy (RIG) is an established way of maintaining enteral nutrition in patients who cannot maintain nutrition orally. The purpose of this study was to evaluate the safety and efficacy of primary placement of a wide bore button gastrostomy in a large, varied patient population through retrospective review. All patients who underwent gastrostomy placement from January 1, 2004 to January 1, 2009 were identified. 18-Fr gastrostomy buttons (MIC-Key G) were inserted in the majority. Follow-up ranged from 6 months to 4.5 years. A total of 260 patients (M:F 140:120, average age 59.2 years) underwent gastrostomy during the study period. Overall success rate for RIG placement was 99.6 %, with success rate of 95.3 % for primary button insertion. Indications included neurological disorders (70 %), esophageal/head and neck malignancy (21 %), and other indications (9 %). Major and minor complication rates were 1.2 and 12.8 %, respectively. Thirty-day mortality rate was 6.8 %. One third of patients underwent gastrostomy reinsertion during the study period, the main indication for which was inadvertent catheter removal. Patency rate was high at 99.5 %. The maximum number of procedures in any patient was 8 (n = 2), and the average tube dwell time was 125 days. Primary radiological insertion of a wide bore button gastrostomy is a safe technique, with high success rate, high patency rate, and low major complication rate. We believe that it is feasible to attempt button gastrostomy placement in all patients, once tract length is within limits of tube length. If difficulty is encountered, then a standard tube may simply be placed instead.

PMO-078 Technical feasibility: mechanically-retained low-profile button gastrostomy

IntroductionA replacement button-gastrostomy has been developed, retained by a mechanical internal fixator formed by loops of the tube shaft. When stretched by the introducer/extractor tool it returns to a completely...

Modified laparoendoscopic gastrostomy tube (LEGT) placement

The purpose of this study was to report the outcomes of our modified LEGT technique. Charts of 26 children who underwent modified LEGT technique between May 2008 and February 2010 were retrospectively reviewed. Their age ranged from 7 days to 16 years. Under general anesthesia, a gastroscope was placed in the stomach and laparoscopic visualization was obtained through a 5 mm umbilical port. Using laparoscopic and gastroscopic visualization, four 2'0' PDS 'T'-Fasteners were placed around a proposed gastrostomy site in the stomach. These sutures were pulled externally and tied subcutaneously so that nothing was visible outside. The gastrostomy button was then placed in the center of these four sutures at the proposed gastrostomy button site. Once the gastrostomy balloon was inflated, the four sutures were pulled taut and tied subcutaneously to pexy the stomach to the abdominal wall. Visualization with the gastroscope and laparoscope ensured proper gastrostomy button placement. At a median follow-up of 9 months (range 10 days-2 years), none of the patients had major complications and only five had minor gastrostomy site infection which completely resolved after antibiotic therapy. LEGT is a safe and effective technique for placement of primary G buttons/tubes in children. The laparoscopic visualization of the LEGT avoids accidental gastro-enteric fistula formation and allows primary placement of the gastrostomy button without need for subsequent procedures. LEGT ensures that the G-button is placed within the gastric lumen. Additionally, the four 'T'-Fastener technique gives optimal fixation of the stomach to the abdominal wall, avoids accidental disruption of sutures as they are placed subcutaneously and has no need for suture removal at a post-operative visit as in other techniques. Since there are no other ports used except the umbilicus this technique provides excellent cosmetic results.

Effect of High-Fidelity Simulation on Pediatric Nursing Students’ Anxiety

This study examined the effect of practice with a high-fidelity infant simulator on anxiety in undergraduate student nurses before the first head-to-toe assessment of a hospitalized child. Students were assigned to experimental (N = 27) and attention intervention (N = 25) groups. The experimental group provided postoperative assessments using the SimBabyTM manikin, and the attention intervention group administered infant formula and oral medications through a gastrostomy button without a manikin. State anxiety (STAI), self-confidence, and satisfaction with the learning experience were measured before and after simulated experiences in the Learning Resources Center, and before and after assessing a hospitalized child. On the students’ first clinical day, anxiety scores were significantly lower than attention intervention students by 12 points before the assessment of a hospitalized child for students who practiced assessment with the manikin. Students provided suggestions for additional pediatric simulations.