Safety and outcomes of percutaneous endoscopic gastrostomy tubes in children

Complications of percutaneous endoscopic gastrostomy in children: a single-center experience

Purpose: Percutaneous endoscopic gastrostomy is the most preferred method for feeding in children with intact gastrointestinal system functions when oral nutrition is insufficient due to neurological, neuromuscular, or oncological diseases. This study aimed to evaluate the indications for percutaneous endoscopic gastrostomy and associated complications in the patients we followed up. Materials and Methods: In this descriptive study, the records of 130 patients who underwent percutaneous endoscopic gastrostomy for nutritional support between January 1st 2013- December 30th 2020 were retrospectively reviewed. Demographic data, indications, complications, and follow-up periods of the patients were examined. Results: Of the patients, 75 were male and 55 were female. The mean age of the patients was 48 months (min 1 month-max 211 months). The evaluation of the patients with percutaneous endoscopic gastrostomy in terms of diagnosis revealed that 95 patients required nutritional support due to neuromotor retardation associated with neurological disease, 19 patients due to central nervous system tumor, and 13 patients due to metabolic disease. Considering complications, the most frequent minor complication was leakage in 11of the 33 patients, while the most frequent major complication was colonic fistulation in 6 of the 9 patients. Two patients required open surgery in the early period due to intra abdominal leak. Conclusion: Although enteral nutrition with a percutaneous endoscopic gastrostomy tube seems to be an appropriate and reliable method to meet the nutritional needs of pediatric patients who have normal digestive system functions but cannot be fed orally due to swallowing disorders, it is necessary to pay attention to its complications like any surgical procedure.

Laparoscopic Roux-en-Y feeding jejunostomy as a long-term solution for severe feeding problems in children

Enteral feeding is a common problem in children with gastric emptying disorders. Traditional feeding methods in these patients often show a high rate of complications and maintenance issues. Laparoscopic Roux-en-Y feeding jejunostomy (LRFJ) has been described in a few patients as a minimal invasive option for enteral access in these children. The aim of this study is to evaluate the outcomes of the LRFJ procedure in our tertiary referral center. We conducted a retrospective case-series including all patients, aged 0-18 years old, that underwent a LFRJ procedure between August 2011 and December 2020 for the indication of oral feeding intolerance due to delayed gastric emptying. Outcomes evaluated were complications (short and long term) and parenteral satisfaction. In total, 12 children were identified that underwent LRFJ for the indication of oral feeding intolerance due to delayed gastric emptying. A total of 16 complications were noted in 8/12 patients (67%). Severity classified by Clavien-Dindo were grade I (n = 13), grade II (n = 1), and grade IIIB (n = 2). In 11/12 patients, parents were satisfied with the results.

CONCLUSIONS

Although minor complications after LRFJ are common in our patients, this technique is a safe solution in patients with gastric emptying disorders leading to a definitive method of enteral feeding and high parenteral satisfaction.

WHAT IS KNOWN

• Traditional tube feeding in children (duodenal, PEG-J-tubes) with severe delayed gastric emptying can be challenging with a high rate of complications and maintenance issues. • Open loop jejunostomy and Roux-en-Y jejunostomy are alternative, permanent methods of feeding but either invasive or are accompanied by severe complications. Little is known in the literature about laparoscopic Roux-en-Y feeding jejunostomy.

WHAT IS NEW

• Laparoscopic Roux-en-Y feeding jejunostomy is a permanent, safe and minimal invasive alternative option for enteral feeding in children with severe delayed gastric emptying..

Gastroenterologist's Guide to Gastrostomies

Gastroenterologists are frequently consulted for evaluation feeding tube placement, or for management of complications in an existing feeding tube. Though a frequent topic of consultation for GI Fellows, there are few comprehensive resources for feeding tube placement and troubleshooting available. In this review, we discuss different types of feeding tubes, when each should be considered, and various methods and techniques for placement. Considerations for when one type, method, technique, or specialty may be preferred over the other will be discussed. Additionally, we discuss management of the many complications of indwelling feeding tubes. Our goal is to create a comprehensive review for gastroenterologists to cover clinically relevant questions related to feeding tube placement and management.