Gastrostomy Tubes In Children Research Articles

How many tests does it take? Minimizing preoperative testing prior to surgical placement of gastrostomy tubes in children.

Gastrostomy tubes (GTs) provide life-saving enteral access for children. Although upper gastrointestinal (UGI) series and impedance studies (ISs) detect gastroesophageal reflux disease (GERD) or malrotation, their benefit for preoperative evaluation of asymptomatic patients requiring GT placement is controversial. This study investigated the value of routine preoperative testing and whether specific patient characteristics could guide the selective use of these studies. The charts of children who underwent GT placement from 2003 to 2019 were reviewed retrospectively. Demographics, preoperative evaluation, and postoperative course were evaluated. Three hundred forty-three patients underwent GT placement, 61% with preoperative testing. Seven of 190 UGI (4%) series demonstrated malrotation, and 39 of 141 (28%) ISs revealed severe GERD. Although all malrotations were surgically addressed, only 59% (23/39) of IS-proven GERD cases prompted simultaneous fundoplication. Age <1 year was associated with a positive UGI series (6.7% positive vs 1.0%; P < 0.05), but no other patient characteristics were associated with either positive UGI series or IS. Elimination of the 96% of UGI series that did not alter care represented a cost savings of $89,487-$229,665 and avoided the radiation exposure from testing; elimination of the 84% of ISs that did not alter eventual treatment would have saved $127,776-$266,563. Routine preoperative evaluation with UGI series and IS can increase healthcare costs without substantially altering care. The only patients potentially benefiting from routine UGI series were <1 year old. Instead, a targeted, symptom-based preoperative evaluation may streamline the process by decreasing preoperative testing and minimizing cost and radiation exposure.

Upper Gastrointestinal Series in the Workup for Pediatric Gastrostomy Placement: Does it Delay Care?

IntroductionUpper gastrointestinal (UGI) series is often part of the workup prior to the placement of gastrostomy tubes in children. Prior studies have suggested UGI to be limited in utility and an extra financial burden. The goal of this study was to investigate the utility and cost of UGI studies. MethodsA retrospective, case control study of patients aged < 18 y receiving gastrostomy tubes at a free-standing children's hospital between 2012 and 2017. Total costs were obtained from the Pediatric Health Information System. ResultsSix hundred eighty five patients underwent gastrostomy placement during the study period. UGI was obtained in 90.8% of patients; 23.6% of studies were abnormal. The most common abnormal findings were reflux (13.8%) and abnormal anatomy (5.8%). The median time to obtain a UGI was 0.82 d (interquartile range 0.22-1.05). Obtaining a UGI was associated with delayed care in 104 patients (15.2%). If a delay was encountered, median time was 2.47 d (interquartile range 1.86-2.99). Ladd's procedures were performed in 12 patients (1.7%) found to have malrotation on UGI. None of the 63 patients who did not undergo UGI required a Ladd's procedure. Patients that had a UGI did not experience an increase in overall length of stay (14.3 versus 15.6 d, excluding intensive care unit patients), operative time (34 versus 39 min), or a change in rate of operative complications (11.5% versus 14.3%). In addition, UGI did not have a significant impact on total adjusted costs ($49,844 versus $83,438 without UGI, P = 0.12) but did slightly increase total adjusted costs per day ($2212 versus $1999 without UGI, P = 0.01). ConclusionsUGI prior to gastrostomy placement in children rarely identified abnormal findings that changed the operative plan, was associated with delayed care in 15% of patients, and was associated with slightly increased costs per day. Further analyses to identify subsets of children that may benefit from routine UGI are warranted.

Safety and outcomes of percutaneous endoscopic gastrostomy tubes in children.

Gastrostomy tube feeding is indicated for children who require prolonged enteral tube feeding. Different techniques for gastrostomy tube insertion exist, and include percutaneous endoscopic gastrostomy (PEG) tube insertion. Our primary goal was to review the indications, associated complications, and outcomes from PEG tube insertion in children treated in our institution. Our secondary goal was to assess possible risk factors for the associated complications. This was a retrospective chart review study. It involved children who had received PEG tubes between 2017 and 2019. Data collected included demographics, indications for PEG placement, associated comorbidities, minor and major complications encountered, and patients' outcomes after PEG placement. . Statistical analysis was performed to determine possible risk factors for predicting the encountered complications. A total of 25 PEG tubes were placed during the study period. There were 14 females (56%), and the average age of the patients was 43.8 months (range: 1-188 months). The most common indication for PEG placement was failure to thrive (40%), followed by feeding problems (32%) and recurrent aspiration (28%). Neurological conditions (84%) were the most common associated comorbidity, followed by hematological (44%) and genetic (24%) conditions. A very small percentage (4%) experienced one major complication, and about 32% of the patients experienced at least one minor complication. The most common minor complication was PEG tube site infection. No risk factors could predict the encountered complications. PEG tube placement continues to be a safe technique in children. The most common indication of PEG placement is failure to thrive. PEG tube site infection continues to be the most common minor complication associated with PEG placement. No specific risk factors were found to predict the encountered complications.

A comparison of balloon and nonballoon gastrostomy tubes in children

PurposeThe purpose of this study was to compare primary outcomes following insertion of balloon and nonballoon gastrostomy tubes (G-tubes). MethodsA retrospective chart review over a 5-year period comparing the need for emergency, radiologic, or operative interventions between balloon and nonballoon G-tube devices was performed. Results145 patient charts were reviewed (46.8% female, 53.1% male). The indication for G-tube insertion was failure to thrive in 83.4%. Average age at insertion was 4.3 years (0–17.9 years). 37.2% had a balloon type G-tube, and 62.8% had a nonballoon type. Patients with a nonballoon device had 1.14 (0–15) ER visits related to the G-tube vs. 0.48 (0–6) visits with a balloon device. Of the ER visits for patients with a nonballoon device, 26.9% were replaced in ER, 38.5% in radiology, and 34.6% required an operation for replacement. For patients with a balloon device, 47.8% were replaced in the ER, 52.2% were replaced in radiology (GJ), and none required operative replacement. The majority of patients who initially had a nonballoon G-tube placed required a second operation for device change (95.7%). Patients with nonballoon devices required significantly more operations (average 2.55, range 0–16) vs patients with balloon devices (average 0.40, range 0–3) (p < .05). ConclusionsBalloon-type G-tubes require less ER visits and operative interventions compared to nonballoon G-tubes. Level of evidenceC

Quality Improvement Initiative: The Administration of Early Nutrition Following Percutaneous Endoscopic Gastrostomy Tube Placement in Children.

It is common practice for providers to wait up to 24 hours to begin enteral feedings using a newly placed gastrostomy tube in children. As a quality improvement initiative, guidelines were developed to begin early enteral nutrition 4 hours following gastrostomy tube placement. These patient care guidelines standardized electronic ordering, dosing, and feeding administration instructions. Healthcare professionals from the departments of gastroenterology, case management, and nutrition were asked to evaluate the new process by completing a questionnaire. Changes were made to the quality improvement initiative on the basis of the feedback received from the questionnaires. The early feeding initiative aimed to improve patient outcomes and enhance the quality of care received following the child's gastrostomy procedure. These guidelines will then be used in a prospective clinical trial to evaluate the validity of the quality improvement initiative.

Management of early dislodgment of gastrostomy tubes in children

Management of early dislodgment of gastrostomy tubes in children

Factors Affecting Spontaneous Closure of Gastrocutaneous Fistulae After Removal of Gastrostomy Tubes in Children With Intestinal Failure.

Children with intestinal failure (IF) frequently require gastrostomy tubes (GTs) for long-term nutrition support. Risk factors for persistent gastrocutaneous fistulae (GCFs) in pediatric patients with IF are largely unknown but may include underlying nutrition status and duration of indwelling GT. Records of patients with IF having undergone GT removal and allowed a trial at spontaneous closure were reviewed. Nonparametric continuous variables were analyzed using the Wilcoxon rank sum test. Post hoc analysis was performed to identify the optimal threshold of GT duration predicting probability of spontaneous closure identified using receiver operating characteristic curve analysis. Fifty-nine children with IF undergoing GT removal were identified. Spontaneous closure occurred in 36 (61%) sites, while 23 (39%) underwent operative closure at a median 67 days after GT removal. The duration of indwelling GT was significantly shorter in the spontaneous closure group (11.5 vs 21 months, P = .002). Of 33 GT indwelling for ≤ 18 months, 28 (85%) closed spontaneously, compared with only 9 of 26 (35%) with duration >18 months (P < .001). With GCF persisting beyond 7 days, only 21% (6/28) of sites closed spontaneously, but this dropped to 6% (1/18) of cases with concurrent GT duration >18 months. Of the risk factors evaluated, only prolonged GT duration was associated with an increased likelihood of failure to close spontaneously. It is significantly less likely in pediatric patients with IF in whom GCF persists >7 days, particularly if the duration of GT is >18 months. Relatively earlier operative closure should be considered in this group.

A simple method for percutaneous endoscopic gastrostomy tube removal: “Tie and retrograde pull”

Background/PurposeVarious techniques have been presented to remove the percutaneous endoscopically placed gastrostomy tube in children, but tubes with semi-rigid internal retaining discs are difficult or impossible to remove by external traction. We describe a simple and effective endoscopic removal technique that should be applicable to any type of percutaneous endoscopic gastrostomy tube. MethodsPercutaneous endoscopic gastrostomy tube removal was performed with the “tie and retrograde pull” technique. After a polypropylene suture was placed and tied 1cm over the skin level, the percutaneous endoscopic gastrostomy tube was cut 0.5cm over the knot. The suture was cut from the connection point between the needle and the suture. The distal end of the suture was pushed through the stoma into the stomach. Then a forceps was inserted through the gastroscope. The suture was caught, and the residual percutaneous endoscopic gastrostomy portion was retrieved via retrograde traction on the suture. ResultsThe causes of exchange were determined to be planned tube replacement in 9, buried bumper syndrome in 1, and tube occlusion in 3 patients. The mean tube dwell time was 10.8±3.9months. Esophageal mucosal tear developed in 1 patient with epidermolysis bullosa during removal. No other complications occurred during PEG tube exchanges. ConclusionThis is a rapid and useful technique that does not require any complex endoscopic devices.

Prospective Randomized Comparative Study of Low‐Profile Balloon Gastrostomy Tubes in Children

Supplemental enteral nutrition through gastrostomy tubes is well established in children, but prospective studies comparing different tubes remain lacking in this population. The study aimed at comparing different aspects related to the use of low-profile balloon gastrostomy tubes in children. The authors prospectively studied the use of 2 tube types--tube A (MIC-Key gastrostomy tube; Ballard Medical Products, Draper, UT) and tube B (MINI One gastrostomy tube; Applied Medical Technology, Brecksville, OH)--in a cohort of children in a crossover study design. Children were randomly assigned to 1 tube type for 4 months, followed by the other tube type for the next 4 months. Patients were evaluated at enrollment and at 4 and 8 months, with monitoring phone calls at 2 and 6 months. Variables measured included caregiver satisfaction, tube-related complications, and device durability. Twenty-one patients were included in the study. Infection rate (range, 4.8%-5.0%) and overall leakage rate (range, 42.9%-50.0%) were similar in both groups. Trends were noted with other variables measured but without statistical significance. These included lower rates of formula leakage and granulation tissue growth and higher satisfaction scores with tube B and more favorable device durability with tube A. Both low-profile balloon gastrostomy tubes performed well and had comparable caregiver satisfaction, complications, and overall device durability.

Percutaneous gastrostomy tubes in children with Pierre Robin sequence: efficacy, maintenance and complications

Children with Pierre Robin sequence (PRS) have significant oropharyngeal abnormalities, with respiratory and feeding difficulties. Gastrostomy tubes (G-tube) provide a means for nutrition. To evaluate the safety and efficacy of percutaneous G-tube insertion in children with PRS. Of 120 children with PRS (1996-2009), 40 were referred for G-tube insertion; clinical details were reviewed in 37/40 children (18M, 19F) at three time periods: (1) pre-G-tube insertion, (2) at G-tube insertion, (3) at G-tube removal. Pre-G-tube: 32/37 were term infants; 5 were preterm; 16/37 children were ≤ 10th weight percentile. At G-tube insertion, mean age was 66 days, mean weight 4.4 kg (1.1-7.0 kg); 19 dropped ≥10 weight percentiles; 12 tolerated nil by mouth; 2/37 were intubated for the procedure. All G-tubes were successfully placed, with five minor technical issues. Early postprocedure, there were eight minor complications and two dislodgements (classified as major). At G-tube removal mean G-tube dwell time was 2 years, with an average of 3.6 maintenance procedures per child, approximately 3 tube changes/1,000 tube days. At G-tube removal, 76% had maintained or increased weight centiles. G-tubes in PRS provide a safe method for nutrition until children feed adequately by mouth.

Use of Gastrostomy Tubes in Children and Adolescents With Eating Disorders and Related Illnesses

The aim of this case series was to describe five youths with psychiatric illnesses who underwent feeding tube placement as part of their treatment. The database of a Canadian academic tertiary care eating disorder program was used to identify patients with feeding tubes. Five patients with feeding tubes were identified in the database of more than 600 patients. Of the five patients, two had anorexia nervosa and three suffered from food refusal as a result of a psychiatric illness unrelated to body image issues. For each patient, the tube was placed only after standard methods of treatment had failed, including repeated hospitalizations and in two cases, residential treatment. The primary goal of placing the tube was to allow for outpatient management of the patient. In all five cases, the healthy weight was restored, and four of the five patients experienced a significant improvement in independent eating behavior. Four of the five patients were found to have had their tube removed when this article was being written. None of the patients required further hospitalizations and no serious relapses were found to have occurred. This case series demonstrates that gastrostomy tube feeding can be an effective intervention to allow patients with eating disorders to be treated as outpatients. The limitations of this study include the small study size, the retrospective nature of the study, and the short follow-up after tube removal. Further study is needed to evaluate the psychological effects of enterostomy feeds in patients and their families.

Use of Gastrostomy Tubes in Children and Adolescents with Eating Disorders and Related Illnesses: A Retrospective Case Series

The aim of this case series was to describe five youths with psychiatric illnesses who underwent feeding tube placement as part of their treatment.

A Descriptive Study of Complications of Gastrostomy Tubes in Children

The purpose of this study was to determine the number and types of complications experienced by children with gastrostomy tubes. This is a prospective study of children with gastrostomy tube complications. Enrollment occurred on the first 24 months of the study. Data were collected for 4 years, beginning at the enrollment of the first participant. Demographic data and information on infections, granulation tissue formation, and major complications were recorded. Infections occurred in 37% of patients, with most experiencing a single infection that occurred within the first 15 days after tube placement. Granulation tissue developed in 68% of patients, with 17% experiencing recurrent granulation tissue despite treatment. There was no difference in infection rates or granulation tissue formation between subgroups based on gender, ethnicity, or parents' education level. Major complications occurred in 4% of the patients. Complications of infection and granulation tissue occur frequently and likely are a cause of stress and increased burden of care for these children and families. Improved strategies for care are needed.

Erreurs dans l'administration des médicaments par les dispositifs des gastrostomies : étude chez 109 enfants

Gastrostomy is frequently used in clinical practice for drug administration. However modalities of drug administration via a gastrostomy device have been poorly studied and remain uncodified. Aim To assess the mode of administration of drugs as well as errors associated with the use of a gastrostomy devices for drug delivery in children. Patients and methods Mode of administration of drugs was studied in 109 children (mean age 8.4 ± 5.5 years, 72% neurologically impaired, 41% institutionalized children). A questionnaire was filled in by parents and/or caregivers. Errors of administration were classified as follows: galenic, due to preparation, physico-chemical interaction, lack of flushing the tube. Factors influencing the occurrence of errors were studied: living at home or in an institution, underlying disease, number of drugs administered via gastrostomy device. Results Errors were frequently observed: galenic (47%), due to preparation (42%), physico-chemical interaction (51%), lack of flushing (10%). Errors occurred more frequently in institutionalized children compared to children living at home (78 versus 25%, P < 0.0005). Galenic errors were more frequent in neurologically impaired children (57 versus 30%, P < 0.005). Conclusion Many medications are administrated via gastrostomy tube in children. Errors are frequently observed and potentially dangerous.

Persistence of gastrocutaneous fistula after removal of gastrostomy tubes in children: prevalence and associated factors.

The aims of this study were to determine the prevalence of gastrocutaneous fistula after removal of gastrostomy tubes in children and to identify associated risk factors. The records of children who had undergone removal of gastrostomy tubes between January 1992 and December 2002 were reviewed retrospectively. Persistent gastrocutaneous fistula was defined as the absence of closure of the gastrostomy 1 month after tube removal. Factors that might influence spontaneous closure of the gastrostomy were studied, including age, underlying disease, nutritional status, type of gastrostomy, replacement of the gastrostomy tube by a button, abdominal wall thickness, duration of gastrostomy tube or button placement, and complications related to the presence of the gastrostomy (infection, granulation tissue). A total of 44 patients were included in the study (mean age 20 months, range 1 day to 14 years). Of these, 28 had undergone percutaneous endoscopic gastrostomy and 16 surgical gastrostomy. The mean time to spontaneous closure was 6 +/- 7 days. Persistent gastrocutaneous fistula developed in 11 patients (25 %) and in seven of these patients this required surgical closure (16 %). The mean duration of gastrostomy placement was significantly longer in patients who went on to develop a gastrocutaneous fistula than in patients who did not develop a fistula (39 +/- 19 months vs. 22 +/- 23 months, respectively, P < 0.03). No other significant association was found between the time required for spontaneous closure and the characteristics of patients or the type of gastrostomy. Persistent gastrocutaneous fistula is common after removal of gastrostomy tubes in children. Surgical closure should be considered when a gastrostomy has not closed spontaneously 1 month after removal of the gastrostomy tube.

Reply to Migration of Percutaneous Endoscopic Gastrostomy Tube in Children

Reply to Migration of Percutaneous Endoscopic Gastrostomy Tube in Children

Reply to Migration of Percutaneous Endoscopic Gastrostomy Tube in Children

Reply to Migration of Percutaneous Endoscopic Gastrostomy Tube in Children

Migration of Percutaneous Endoscopic Gastrostomy Tube in Children

Migration of Percutaneous Endoscopic Gastrostomy Tube in Children

Complications of removing percutaneous endoscopic gastrostomy tubes in children.

Little information has been reported regarding the frequency and type of complications arising from removal of percutaneous endoscopic gastrostomy (PEG) tubes in children. The records of 397 patients who had PEG tubes placed from 1993 through 1998 were reviewed for complications after removal. Data collected included length of time the tube was in place, age of the patient at insertion, type of tube removed, and patient diagnosis. Fifty-four children had the PEG tube removed by traction or endoscopy. The only complication was persistent leaking through a gastrocutaneous fistula in 13 patients (24%). Leaking ceased in 6 children coincident with H2-antagonist therapy and silver nitrate cautery, and surgical closure of the fistula was required in 7 patients. Comparison of these 7 children with those who did not require surgery (n = 47) showed a longer duration of tube placement (mean +/- SE of 20.6+/-3.6 months, range 11-31 months vs. 11.1+/-1.3 months, range 1-35 months; P<0.05). Further analysis showed no child with a PEG tube removed before 11 months (n = 23) after insertion required surgery, whereas 7 (23%) of 31 children with a PEG tube removed after 11 or more months required surgery. Age at insertion, type of feeding device removed, and patient diagnoses were not different between the two groups. These data indicate that persistent leaking necessitating surgical closure of a gastrocutaneous fistula does not occur in children with a PEG tube removed within 11 months of insertion. In contrast, 23% of children with a PEG tube removed 11 or more months after insertion require surgery. In patients identified as candidates for tube removal, this time frame may be important in clinical decision making.

Risks of Gastrostomy Tubes in Children on Peritoneal Dialysis

Risks of Gastrostomy Tubes in Children on Peritoneal Dialysis