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Blashinsky ZA, Calafell JA. Malposition of Percutaneous Endoscopic Gastrostomy (PEG) Tube Through the Transverse Colon: A Novel Approach to Conservative Management. Cureus 2024; 16:e63908. [PMID: 39105023 PMCID: PMC11298332 DOI: 10.7759/cureus.63908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/03/2024] [Indexed: 08/07/2024] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is a common technique for enteral nutrition support. Complications range from skin injuries and leakage to more severe intraabdominal pathologies. This case report describes a patient with invasive right lateral pharyngeal wall squamous cell carcinoma who developed a gastrocolocutaneous fistula following PEG tube malpositioning in the transverse colon performed at an outside institution. Based on the patient's comorbidities and the associated high-risk nature of the surgery, a transverse colectomy and partial gastrectomy to resect the malpositioned tube followed by a new PEG tube was deemed invasive and would likely have a poor clinical outcome. Instead, the surgeon performed a laparoscopic-assisted PEG tube insertion in another portion of the stomach. The fistulous tract of the original PEG tube was completely sealed and fell out one week following surgery. The patient tolerated feeds through the new PEG tube site. Gastrocolocutaneous fistulas are rare complications of PEG tube insertion with a poorly understood pathophysiology. Here, we analyze the root cause of this condition, steps to mitigate it, and a proposed novel surgical approach for its conservative management.
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Affiliation(s)
- Zachary A Blashinsky
- Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
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2
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Lee S, Ko A, Park S, Kim KW, Ihn K, Ho IG, Kim SH, Kim HD, Lee JS, Kang HC. Efficacy of enteral feeding by gastrostomy tube placement in patients with Lennox-Gastaut syndrome on body weight and days of hospitalization: A retrospective case series. Nutr Clin Pract 2024. [PMID: 39030737 DOI: 10.1002/ncp.11177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND Lennox-Gastaut syndrome (LGS) is a severe form of drug-resistant epilepsy that begins during childhood and frequently leads to significant neurological impairments. Patients with LGS are likely to receive improper oral nutrition because of issues such as dysphagia and aspiration risk, potentially resulting in long-term tube feeding and eventual gastrostomy tube placement. Therefore, we investigated the effects of gastrostomy tube placement on nutrition outcomes and frequency of hospitalization in LGS. METHODS We retrospectively examined 67 patients diagnosed with LGS who had undergone gastrostomy tube placement between January 2005 and August 2022. Comprehensive clinical data and complications arising from the procedure were collected. Patients' nutrition condition and frequency of hospitalizations were analyzed before and after gastrostomy tube placement. RESULTS Gastrostomy tube placement was performed for the following reasons: high risk of aspiration (50 out of 67, 74.6%), dysphagia (13 out of 67, 25.4%), persistent nasogastric tube feeding (2 out of 67, 3.0%), and severe malnutrition (2 out of 67, 3.0%). After the procedure, z scores for weight-for-age improved significantly, shifting from -3.35 ± 3.57 to -2.54 ± 2.70 over a 2-year interval (P < 0.001). Additionally, the total days of hospitalization and days of hospitalization due to respiratory symptoms reduced significantly from 41.94 ± 51.76 to 15.27 ± 26.68 (P < 0.001) and from 23.75 ± 36.92 to 10.52 ± 22.98 (P = 0.009), respectively. Among the patients, 50 (74.6%) experienced complications resulting from gastrostomy, with a relatively small proportion of major complications (11 out of 67, 16.4%) and no mortality. CONCLUSION Gastrostomy tube placement is a relatively safe procedure with favorable effects on nutrition status and hospitalization rates in patients with LGS.
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Affiliation(s)
- Sangbo Lee
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ara Ko
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sowon Park
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyong Ihn
- Division of Pediatric Surgery, Department of Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - In Geol Ho
- Division of Pediatric Surgery, Department of Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hee Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Epilepsy Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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3
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Bourezma M, Mur S, Storme L, Cailliau E, Vaast P, Sfeir R, Lauriot Dit Prevost A, Aubry E, Le Duc K, Sharma D. Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic Hernia. J Clin Med 2023; 12:jcm12062415. [PMID: 36983415 PMCID: PMC10059888 DOI: 10.3390/jcm12062415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Congenital diaphragmatic hernia (CDH) is a rare disease associated with major nutritional and digestive morbidities. Oral feeding autonomy remains a major issue for the care and management of these patients. The aim of this study was to specify the perinatal risk factors of delayed oral feeding autonomy in patients treated for CDH. METHODS This monocentric cohort study included 138 patients with CDH. Eighty-four patients were analyzed after the exclusion of 54 patients (11 with delayed postnatal diagnosis, 5 with chromosomal anomaly, 9 with genetic syndrom, 13 with right-sided CDH, and 16 who died before discharge and before oral feeding autonomy was acquired). They were divided into two groups: oral feeding autonomy at initial hospital discharge (group 1, n = 51) and nutritional support at discharge (group 2, n = 33). Antenatal, postnatal, and perisurgical data were analyzed from birth until first hospital discharge. To remove biased or redundant factors related to CDH severity, statistical analysis was adjusted according to the need for a patch repair. RESULTS After analysis and adjustment, delayed oral feeding autonomy was not related to observed/expected lung-to-head ratio (LHR o/e), intrathoracic liver and/or stomach position, or operative duration. After adjustment, prophylactic gastrostomy (OR adjusted: 16.3, IC 95%: 3.6-74.4) and surgical reoperation (OR adjusted: 5.1, IC 95% 1.1-23.7) remained significantly associated with delayed oral feeding autonomy. CONCLUSIONS Delayed oral feeding autonomy occurred in more than one third of patients with CDH. Both prophylactic gastrostomy and surgical reoperation represent significant risk factors. Bowel obstruction might also impact oral feeding autonomy. Prophylactic gastrostomy seems to be a false "good idea" to prevent failure to thrive. This procedure should be indicated case per case. Bowel obstruction and all surgical reoperations represent decisive events that could impact oral feeding autonomy.
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Affiliation(s)
- Mélina Bourezma
- CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France
| | - Sébastien Mur
- CHU Lille, Clinic of Neonatology, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
| | - Laurent Storme
- CHU Lille, Clinic of Neonatology, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
| | - Emeline Cailliau
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
- Biostatistics Department, CHU Lille, FR-59000 Lille, France
| | - Pascal Vaast
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- CHU Lille, Clinic of Obstetrics and Gynaecology, Jeanne de Flandre Hospital, FR-59000 Lille, France
| | - Rony Sfeir
- CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France
| | | | - Estelle Aubry
- CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
| | - Kévin Le Duc
- CHU Lille, Clinic of Neonatology, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
| | - Dyuti Sharma
- CHU Lille, Clinic of Pediatric Surgery, Jeanne de Flandre Hospital, FR-59000 Lille, France
- Center for Rare Disease Congenital Diaphragmatic Hernia, CHU Lille, Jeanne de Flandre Hospital, FR-59000 Lille, France
- ULR 2694-METRICS: Medical Practices and Health Technology Evaluation, CHU Lille, Université de Lille, FR-59000 Lille, France
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Attia AC, Childers WK. Percutaneous endoscopic gastrostomy tube replacement after head and neck surgery: A case report. Int J Surg Case Rep 2022; 96:107323. [PMID: 35779317 PMCID: PMC9283987 DOI: 10.1016/j.ijscr.2022.107323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Percutaneous endoscopic gastrostomy (PEG) has been available since the 1980s. Routine replacement is conducted at bedside with relatively few complications. Two replacement methods have come into practice: the percutaneous method and the endoscopic method. The laparoscopic method has recently become favorable in the pediatric population. PRESENTATION OF CASE Herein, we describe a situation in which a gastrostomy tube was replaced at bedside on a patient with previous head and neck surgery for lingual cancer. The percutaneous traction method was used, and gastrostomy tube replacement into the gastric lumen could not be confirmed on subsequent imaging. The patient was ultimately taken to surgery for an open procedure where it was discovered that initial PEG placement had traversed the small bowel mesentery en route to the gastric lumen. DISCUSSION The PEG tube is not a permanent device and routine exchange every 6-12 months is recommended. The percutaneous method and endoscopic method for gastrostomy tube replacement have both been used routinely, each with their set of complications. A third technique, laparoscopic placement, is the preferred modality in the pediatric population. Advantages are twofold: direct visualization of the stomach, thus eliminating inadvertent hollow viscus injury, and applicability in infants too small to undergo endoscopy necessary for PEG tube placement. CONCLUSION Consideration for laparoscopic placement or replacement in the head and neck cancer patient population, in which interval endoscopy is impossible, is thus advocated.
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Affiliation(s)
- Aria C. Attia
- UPMC Harrisburg, 205 S Front St, Harrisburg, PA 17104, United States of America,Corresponding author.
| | - William Kurtis Childers
- UPMC Harrisburg, Department of General Surgery, 205 S Front St, Harrisburg, PA 17104, United States of America
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Osei H, Munoz-Abraham AS, Martino A, Chatoorgoon K, Greenspon J, Fitzpatrick C, Villalona GA. To Button or Not to Button? Primary Gastrostomy Tubes Offer No Significant Advantage Over Buttons. Pediatr Gastroenterol Hepatol Nutr 2022; 25:211-217. [PMID: 35611372 PMCID: PMC9110846 DOI: 10.5223/pghn.2022.25.3.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/25/2022] [Accepted: 04/02/2022] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Outcomes between primary gastrostomy tubes and buttons (G-tube and G-button) have not been established in pediatric patients. We hypothesized that primary G-tube have decreased complications when compared to G-button. METHODS A retrospective review of surgically placed gastrostomy devices from 2010 to 2017 was performed. Data collected included demographics, outcomes and 90-day complications. We divided the patients into primary G-tube and primary G-button. RESULTS Of 265 patients, 142 (53.6%) were male. Median age and weight at the time of surgery were 7 months (interquartile range [IQR], 2-44 months) and 6.70 kg (IQR, 3.98-14.15 kg), respectively. Among the groups, G-tube had 80 patients (30.2%) while G-button 185 patients (69.8%). There were 153 patients with at least one overall complication within 90 days postoperative. There was no significant difference in overall complications between groups (G-tube 63.8% vs. G-button 55.7%, p=0.192). More importantly, there were no significant differences in major complications among the groups, G-tube vs. G-button (5% vs. 4%; p=0.455). CONCLUSION Primary G-tube offers no significant advantage in overall, minor or major complications when compared to primary G-button.
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Affiliation(s)
- Hector Osei
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | | | - Alice Martino
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Kaveer Chatoorgoon
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.,Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Jose Greenspon
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.,Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Colleen Fitzpatrick
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.,Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Gustavo A Villalona
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.,Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, St. Louis, MO, USA
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6
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Masui D, Fukahori S, Hashizume N, Ishii S, Higashidate N, Koga Y, Sakamoto S, Tsuruhisa S, Nakahara H, Saikusa N, Tanaka Y. Influence of laparoscopy-aided gastrostomy on gastroesophageal reflux in neurologically impaired patients using multichannel intraluminal impedance pH measurements. Esophagus 2022; 19:360-366. [PMID: 34655356 DOI: 10.1007/s10388-021-00888-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Development of gastroesophageal reflux disease (GERD) after gastrostomy remains debatable. Therefore, this study aimed to evaluate whether laparoscopy-aided gastrostomy (LAG) influence on the occurrence of GERD in neurologically impaired (NI) patients. Furthermore, we investigated whether preoperatively excluding NI patients with GERD can reduce the number of patients requiring subsequent anti-reflux surgery (ARS) after LAG. METHODS This retrospective study included 35 NI patients (median age: 11.0; interquartile range 5.0-23.5 years) who underwent LAG according to our criterion from October 2012 to June 2020 and MII-pH before and after LAG. MII-pH parameters were compared in all patients and among three age groups between before and after LAG. RESULTS There were no significant differences in MII-pH parameters before and 1 year after LAG in all patients, and no patient underwent subsequent ARS. Only one paediatric patient with 64 number of reflux episodes before LAG required subsequent ARS 3 years after LAG. CONCLUSIONS Generally, LAG did not influence the postoperative GERD at 1 year after LAG, and our criteria could reduce the number of patients requiring subsequent ARS. However, paediatric NI patients with higher number of reflux episodes in preoperative MII-pH study may need careful long-term follow-up after LAG.
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Affiliation(s)
- Daisuke Masui
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Suguru Fukahori
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Naoki Hashizume
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Shinji Ishii
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Naruki Higashidate
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yoshinori Koga
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Saki Sakamoto
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Shiori Tsuruhisa
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hirotomo Nakahara
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Nobuyuki Saikusa
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yoshiaki Tanaka
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.,Division of Medical Safety Management, Kurume University School of Medicine, Fukuoka, Japan
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Patel R, Mutalib M, Pradhan A, Wright H, Upadhyaya M. Nurse-led service for children with gastrostomies: a 2-year review. ACTA ACUST UNITED AC 2021; 30:462-466. [PMID: 33876678 DOI: 10.12968/bjon.2021.30.8.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) feeding can provide long-term nutritional support for patients with a functional gastrointestinal system but insufficient oral intake. Some patients, however, may require jejunal feeding, which can be achieved using a PEG tube with jejunal extension (PEG-J). A previous review at a tertiary paediatric hospital revealed poor documentation and a high incidence of buried bumper syndrome (BBS) in children with gastrostomies. Subsequently, a nurse-led service for gastrostomy care was introduced. AIM To determine the impact of the nurse-led service. METHODS Prospective review, at 1 year and 2 years, following either a PEG or PEG-J insertion. Patient records were reviewed and a telephone survey was conducted. Statistical analysis was performed using Fisher's exact test. FINDINGS 32 PEG and 6 PEG-J patients were included in this study. There was 100% documentation of provision of care instructions. Average satisfaction with the service was over 8/10. Incidence of BBS was 0% in the PEG group and 17% in the PEG-J group. Of those parents/carers surveyed, 74% wanted additional tube care support via SMS text message. CONCLUSION Introduction of a nurse-led service resulted in complete documentation of provision of care and sustained high levels of parental satisfaction. Future care should focus on utilising technological platforms.
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Affiliation(s)
- Radhika Patel
- Doctor in training, King's College London School of Medical Education, London
| | - Mohamed Mutalib
- Consultant Paediatric Gastroenterology, Evelina London Children's Hospital, London
| | - Akhilesh Pradhan
- Doctor in training, King's College London School of Medical Education, London
| | - Hannah Wright
- Gastroenterology Clinical Nurse Specialist, Evelina London Children's Hospital, London
| | - Manasvi Upadhyaya
- Consultant Paediatric Surgeon, Evelina London Children's Hospital, London
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Endoscopic vs laparoscopic paediatric gastrostomies: Time to change our practice? J Pediatr Surg 2021; 56:1317-1321. [PMID: 33933266 DOI: 10.1016/j.jpedsurg.2021.03.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/13/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gastrostomy insertion is a common procedure for paediatric surgeons, with the percutaneous endoscopic gastrostomy (PEG) technique long favoured for its simplicity and speed. However, there is growing evidence to suggest that primary laparoscopic balloon gastrostomy (LBG) insertions may have lower complication rates. This study aimed to determine the relative safety and healthcare resource burden of PEG and LBG. METHODS A retrospective review of all primary gastrostomy insertions (2011-2019). Primary outcome measures included return to theatre for emergency laparotomy and healthcare burden (total gastrostomy-related admissions, length of stay and total theatre utilisation). RESULTS 338 PEGs and 277 LBGs were inserted with a minimum follow-up period of six months. Following PEG insertion 12/338(3.6%) children required an emergency laparotomy for gastrostomy-related complications. This compared to 2/277(0.7%) following LBG insertion (ARR2.8% (95%CI0.6-5.0), p < 0.0267). When considering all gastrostomy related admissions, there was no significant difference in total theatre utilisation (PEG = 85 [IQR58-117] minutes, LBG = 86 [IQR75-105] minutes, p = 0.12). However, PEGs were found to have an overall longer length of stay 4 [IQR3-7] vs 3 [IQR2-4] days. CONCLUSIONS LBGs carry a significantly lower rate of major complications and are not associated with an increased healthcare burden. LBG should be considered as the first line method of gastrostomy insertion in children.
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Natesan A, Behar S. Technology-Dependent Children. Emerg Med Clin North Am 2021; 39:641-660. [PMID: 34215407 DOI: 10.1016/j.emc.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There are a growing number of medically complex children with implanted devices. Emergency physicians with a basic knowledge of these devices can troubleshoot and fix many of the issues that may arise. Recognition of malfunction of these devices can reduce morbidity and mortality among this special population. In this article, we review common issues that may arise in children with gastrostomy tubes, central nervous system shunts, cochlear implants, and vagal nerve stimulators.
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Affiliation(s)
- Alamelu Natesan
- Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA. https://twitter.com/amlun
| | - Solomon Behar
- Pediatric Emergency Medicine, Long Beach Memorial/Miller Children's Hospital, 2801 Atlantic Avenue, Long Beach, CA 90806, USA; Voluntary Faculty, Department of Pediatrics, UC Irvine School of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
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Wiernicka A, Matuszczyk M, Szlagatys-Sidorkiewicz A, Zagierski M, Toporowska-Kowalska E, Gębora-Kowalska B, Popińska K, Sibilska M, Grzybowska-Chlebowczyk U, Więcek S, Hapyn E, Blimke-Kozieł K, Kierkuś J. Analysis of frequency and risk factors for complications of enteral nutrition in children in Poland after percutaneous endoscopic gastrostomy placement. Nutrition 2021; 89:111265. [PMID: 34082251 DOI: 10.1016/j.nut.2021.111265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of the study was to assess the complication rate and identify whether age, nutritional status, and history of respiratory aspiration prior to percutaneous endoscopic gastrostomy (PEG) are risk factors for post-PEG placement complications in Polish children. In addition, the safety of two enteral feeding methods (3 h vs. 8 h) after PEG insertion in children was compared. METHODS Children with clinical indications for PEG placement were recruited from six medical centers in Poland to participate in the study. The patients were centrally randomized to receive the first bolus feed via a feeding tube at 3 h (group 1) or 8 h (group 2) after PEG placement. The preprocedural preparation, postoperative care, and resumption of feeding were performed on all of patients in accordance with the study protocol. Patients were followed for 12 mo. RESULTS Of the 97 randomized patients, 49 were assigned to group 1 and 48 to group 2. Full feed after PEG placement was achieved within 24 to 48 h in most cases (74% vs. 82%). There were no differences between the groups regarding the number of early mild (31.3% vs. 31.3%) and serious (2.1% vs 8.3%) complications or the duration of hospitalization after PEG placement (P > 0.05). The most common serious complication after PEG placement was accidental displacement of PEG. Most reported late complications were mild. The results of the regression analysis indicate no statistically significant effect of age, body mass index standard deviation score, white blood cell count, serum albumin level, and respiratory aspiration in the medical history on the occurrence of mild and severe complications. CONCLUSIONS The early initiation of post-PEG feeding was not associated with an increase in the number of complications. Most complications after the PEG procedure were mild. Age, serum albumin level, white blood cells, body mass index standard deviation score, and a history of aspiration to the respiratory tract were not confirmed as a risk factor for post-PEG complications in children.
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Affiliation(s)
- Anna Wiernicka
- Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland.
| | - Małgorzata Matuszczyk
- Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Maciej Zagierski
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Beata Gębora-Kowalska
- Department of Alergology, Gastroenterology and Nutrition, Medical University, Łódź, Poland
| | - Katarzyna Popińska
- Department of Pediatrics, Nutrition and Metabolic Disorders, The Children's Memorial Health Institute, Warsaw, Poland
| | - Marta Sibilska
- Department of Pediatrics, Nutrition and Metabolic Disorders, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Sabina Więcek
- Department of Pediatrics, Medical University of Silesia, Katowice, Poland
| | - Ewa Hapyn
- Department of Pediatrics and Gastroenterology, Area Hospital in Toruń, Poland
| | | | - Jarosław Kierkuś
- Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
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Do Antibiotics Reduce the Incidence of Infections After Percutaneous Endoscopic Gastrostomy Placement in Children? J Pediatr Gastroenterol Nutr 2020; 71:23-28. [PMID: 32205769 DOI: 10.1097/mpg.0000000000002709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Percutaneous endoscopic gastrostomy (PEG) provides a long-term solution for tube dependency. Pediatric guidelines recommend prophylactic antibiotic treatment (ABT) based on adult studies. AIM To compare wound infection and other complications in children receiving a PEG with and without prophylactic ABT. METHODS Retrospective study including children 0 to 18 years undergoing PEG placement. Patients with (2010-2013) and without (2000-2010) ABT were compared with respect to the occurrence of wound infection and other complications. RESULTS In total, 297 patients were included (median age 2.9 years, 53% boys). Patients receiving ABT per PEG protocol (n = 78) had a similar wound infection rate (17.9% vs 21%, P = 0.625), significantly less fever (3.8% vs 14.6%, P = 0.013), leakage (0% vs 9.1%, P = 0.003) and shorter hospital admission (2 vs 4 days, P = 0.000), but more overgranulation (28.2% vs 8.7%, P = 0.000) compared with those without (n = 219). Patients receiving any ABT, per PEG protocol or clinical indication (n = 115), had similar occurrence of wound infection (19.1% vs 20.9%, P = 0.768), fever (7.8% vs 14.3%, P = 0.100) and leakage (3.5% vs 8.8%, P = 0.096), a significantly shorter hospital admission (3 vs 4 days, P = 0.000), but more overgranulation (21.7% vs 8.8%, P =0.003) compared with those without (n = 182). CONCLUSIONS Prophylactic ABT does not seem to reduce the occurrence of wound infection but it might be beneficial with respect to fever, leakage and duration of hospital admission, but not overgranulation. A randomized controlled trial is needed to confirm our results.
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Gulla KM, Sahoo T, Sachdev A. Technology-dependent children. Int J Pediatr Adolesc Med 2020; 7:64-69. [PMID: 32642538 PMCID: PMC7335821 DOI: 10.1016/j.ijpam.2019.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
Abstract
In recent past, revolution in medical technology resulted in improved survival rates and outcomes of critically ill children. Unfortunately, its impact relating to morbidity is not well documented. Although survival rates of these critically ill children who are medically fragile and technology-dependent have improved, we as health professionals are still in the learning curve to improve the quality of life of these children at home. Factors such as support from society, infrastructure, and funding play an important role in technology-dependent child care at home. In this review, commonly prescribed home-based medical technologies such as home ventilation, enteral nutrition, renal replacement therapy, and peripherally inserted central catheter, which are useful for quick revision, are described.
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Affiliation(s)
- Krishna Mohan Gulla
- Division of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Tanushree Sahoo
- Division of Neonatology, All India Institute of Medical Sciences, New Delhi, India
| | - Anil Sachdev
- Division of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
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13
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Cortez AR, Warren PW, Goddard GR, Jenkins TM, Sauser JA, Gerrein BT, Rymeski BA. Primary Placement of a Low-Profile Gastrostomy Button Is Safe and Associated With Improved Outcomes in Children. J Surg Res 2020; 249:156-162. [DOI: 10.1016/j.jss.2019.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/13/2019] [Accepted: 11/23/2019] [Indexed: 12/23/2022]
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14
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Abstract
BACKGROUND/AIM Percutaneous endoscopic gastrostomy tube (PEG) has replaced the standard open surgical gastrostomy for enteral nutrition. However, several complications were reported, especially in children less than 10 kg. Our objective was to report the outcomes of percutaneous endoscopic gastrostomy in children according to their weight. PATIENTS AND METHODS 163 children had PEG tube insertion in our tertiary referral hospital from January 2007 to March 2019. Patients were divided into two groups according to the weight; group I (less than 10 kg; n = 112) and group II (more than 10 kg; n = 51). Comparisons were made between the two groups for incidence of postoperative complications, the need for reintervention, 30-day, and 1-year mortality. RESULTS There were 51 males (45.5%) in group I and 27 in group II (52.9%) (P = 0.38). The mean weight at the time of endoscopy was 5.9 ± 1.53 and 17.3 ± 8.23 kg and the mean American Society of Anesthesiologists (ASA) score was 2.6 ± 0.67 and 2.43 ± 0.57 in group I and II, respectively (P = 0.101). The most common associated condition was cerebral palsy (50 (44.6%) and 24 (47.1%) in group I and II, respectively; P = 0.77). The mean operative time was 30.28 ± 11.57 min in group I and 33.62 ± 23.36 min in group II (P = 0.221). Skin complications were the most commonly encountered complications of PEG, and 49% (n = 48) required the removal and replacement of the tube under general anesthesia in group I and 41% (n = 21) in group II (P = 0.84). There was no significant difference in the complication between groups. CONCLUSION : PEG is a safe technique in children less than 10 kg, and the complications rate is comparable with older children. The use of positive transillumination and small needle for measuring the distance between the skin and the stomach enhances the safety of the procedure. PEG should be considered in children less than 10 kg who need supportive or continuous enteral nutrition for different reasons.
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Affiliation(s)
- Osama A. Bawazir
- Department of Surgery, Faculty of Medicine in Umm Al-Qura University at Makkah, Makkah, Saudi Arabia,Address for correspondence: Dr. Osama A. Bawazir, Department of Surgery, Faculty of Medicine, Umm Al.Qura University, P.O. Box 715, Makkah 21955, Saudi Arabia. King Faisal Specialist Hospital and Research Centre, Dept. of Surgery, Jeddah, KSA. E-mail: ;
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15
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Kumar AS, Bani Yaghoub M, Rekab K, Hall M, Attard TM. Pediatric multicenter cohort comparison of percutaneous endoscopic and non-endoscopic gastrostomy technique outcomes. J Investig Med 2019; 68:413-418. [PMID: 31562228 DOI: 10.1136/jim-2019-001028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 11/03/2022]
Abstract
Enteral access is one of the mainstays of nutritional support. Several different modalities for gastrostomy placement are established. In pediatrics, however, there is a limited evidence base supporting the choice of 1 modality over the others. We retrospectively compared elective percutaneous endoscopically placed gastrostomy (PEG) with surgical and interventional radiology-placed gastrostomy outcomes using the Pediatric Hospital Inpatient Sample multicenter administrative database (Pediatric Health Information System). Pediatric patients (<18 years) undergoing planned elective gastrostomy (2010-2015) were included. Coded gastrostomy procedure subtype, patient demographic characteristics, chronic comorbidities and subsequent related outcomes, mortality, readmission, length of stay and total cost of admission were analyzed. Univariate analysis differentiated among gastrostomy techniques. The effect of gastrostomy on mortality and 30-day readmission were determined using a forward, stepwise, binary logistic regression. Generalized linear models were used to estimate the effect of gastrostomy type on length of stay and total cost. During the study period, 11,712 children underwent gastrostomy, including PEG (27%). Patients with chronic comorbidities were more, or as likely to undergo non-PEG procedures. Postoperatively, PEG patients were less likely to require mechanical ventilation and total parenteral nutrition (TPN). Gastrostomy type was not predictive of mortality; predictors included non-White race and need for mechanically assisted ventilation. Readmission following gastrostomy was common (29.5%), and more likely in PEG patients (OR 1.31). Predictors of readmission included earlier TPN (OR 1.39), cardiovascular (OR 1.17) and oncology (OR 4.17) comorbidities. Our study suggests that PEG placement entails similar length of stay and cost as in non-PEG gastrostomy. Patients undergoing PEG were less likely to require mechanical ventilation and TPN postoperatively. Mortality is similar in both groups although more likely with specific comorbidities. Racial background appeared to be associated with choice of gastrostomy, length of stay and mortality.
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Affiliation(s)
- Ashwath S Kumar
- Pedaitics, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Majid Bani Yaghoub
- Mathematics and Statistics, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Kamel Rekab
- Mathematics and Statistics, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Thomas Mario Attard
- Gastroenterology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
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16
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Franken J, Stellato RK, Tytgat SHAJ, van der Zee DC, Mauritz FA, Lindeboom MYA. Health-related quality of life in children after laparoscopic gastrostomy placement. Qual Life Res 2019; 29:171-178. [PMID: 31420828 PMCID: PMC6962119 DOI: 10.1007/s11136-019-02272-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 12/29/2022]
Abstract
Introduction A gastrostomy placement (GP) is an established treatment to provide enteral feeding in pediatric patients with feeding difficulties aiming to improve nutritional status and health-related quality of life (HRQoL). The aim of this study was to evaluate HRQoL in children with severe feeding difficulties who have undergone GP. Materials and methods A cross-sectional study was performed including 128 patients who had undergone laparoscopic GP (2004–2011). HRQoL was evaluated using the validated Pediatric Quality of Life 4.0 Inventory. Multiple regression analysis was performed to identify predictors of HRQoL. Results After a mean follow-up of 4.0 years (interquartile range 2.9–6.2) after GP, mean HRQoL was 53.0 out of 100 (standard deviation 21.1). HRQoL was significantly lower in children with neurologic impairment, with a mean difference of −21.4 points between neurologically impaired and neurologically normal children (p < 0.001). HRQoL was also lower in children with cardiac disease (−19.0 points; p = 0.01) and in children with a history of previous gastrointestinal surgery (−15.2 points; p = 0.03). Feeding through a gastrojejunostomy tube (−33.0 points; p = 0.01) and higher age at the time of operation (−1.2 points per year; p = 0.03) were also associated with lower HRQoL. GP-related complications requiring reintervention were associated with lower HRQoL, although this association was not statistically significant (p = 0.06). Conclusions Children with severe feeding difficulty, who have undergone GP, have significantly lower HRQoL compared to a healthy pediatric population. Neurologic impairment, cardiac disease, a history of gastrointestinal surgery, older age, and the need for jejunal feeding through the gastrostomy were predictive of even lower HRQoL.
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Affiliation(s)
- Josephine Franken
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Rebecca K Stellato
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Stefaan H A J Tytgat
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Femke A Mauritz
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Maud Y A Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
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17
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Tanaka T, Ueda T, Yokoyama T, Sadamitsu T, Yoshimura A, Horiuchi H, Sawai M, Matsumoto M. Laparoscopic Percutaneous Endoscopic Gastrostomy Is Useful for Elderly. JSLS 2019; 23:JSLS.2019.00011. [PMID: 31148916 PMCID: PMC6535467 DOI: 10.4293/jsls.2019.00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: In recent years, enteral nutrition has become relatively easy to perform through the penetration of percutaneous endoscopic gastrostomy (PEG). However, there have been reports of complications, such as mispuncture of other organs at the time of performing PEG. Previously, we had constructed a gastrostomy under the laparotomy for difficult PEG cases, and 2 years ago, we introduced laparoscopically assisted PEG. This study aimed to clarify the feasibility and safety of LAPEG for elderly people over 65 years old. Methods: We evaluated the perioperative outcomes in 7 elderly patients who underwent LAPEG during these 2 years. In these subjects, the safety of LAPEG was evaluated retrospectively based on the surgical outcomes, perioperative complications, and postoperative course using the clinical archives. Results: The subjects' mean age was 81.1 ± 8.03 years. LAPEG was successful in all 7 patients. The median operation time was 38 minutes (range, 31–71 minutes). Intraoperative and postoperative early or late complications from LAPEG were not observed in our cases. Enteral nutrition was commenced 2 days after PEG placement in all cases without complications. Conclusion: We summarized the LAPEG cases performed at our institution for the elderly, and have reported its feasibility and safety. The strongest advantage of LAPEG was that it allowed placement of the PEG without any complication under direct observation of the intraperitoneal cavity to confirm the safety of each organ.
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Affiliation(s)
- Tetsuya Tanaka
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Takeshi Ueda
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Takashi Yokoyama
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Tomomi Sadamitsu
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Atsushi Yoshimura
- Department of Surgery, Minami-Nara General Medical Center, Nara, Japan
| | - Hazuki Horiuchi
- Department of Gastroenterology, Minami-Nara General Medical Center, Nara, Japan
| | - Masayoshi Sawai
- Department of Gastroenterology, Minami-Nara General Medical Center, Nara, Japan
| | - Masami Matsumoto
- Department of Gastroenterology, Minami-Nara General Medical Center, Nara, Japan
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18
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Kozlov Y, Novozhilov V, Kovalkov K, Rasputin A, Baradieva P, Razumovsky A. Comparison of the Laparoscopic and Open Methods of Gastrostomy at Neonates and Infants Up To Three Months of Age. J Laparoendosc Adv Surg Tech A 2019; 29:958-964. [PMID: 31107138 DOI: 10.1089/lap.2018.0106] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: An open surgical intervention is a common approach for gastrostomy tube placement in neonates and infants. Also available, however less often used, is a laparoscopic technique for low-profile gastrostomy tube (button) placement. In this study we compare the pre-, intra-, and post-procedural outcomes of each technique. Methods: We retrospectively evaluated all open and laparoscopically inserted gastrostomies at our department from January 2002 to December 2016 and compared them in terms of operative parameters and outcomes. Results: In the study interval, 44 open and 90 laparoscopically placed low-profile (button) gastrostomies were performed. There were no significant differences in gender distribution, mean age (42.54 versus 34.16 days), and mean weight (3311 versus 3476 g). The frequency of concomitant Nissen fundoplication was higher in the laparoscopy group (18% versus 47%; P < .05). The duration of G-tube placement by laparotomy was significantly longer (mean difference 16 minutes), than by laparoscopy, as were time periods between G-tube insertion and the onset of first feeding (mean differences 8.4 and 19.6 hours, respectively). Children in the laparoscopy group spent nearly 15 fewer days in the hospital than those who received a G-tube by laparotomy (29.0 versus 13.9; P < .05). Major complications were observed in 3 (6.82%) patients in the laparotomy group in the form of gastric content leak into the abdominal cavity and resulting peritonitis; complications were lower in the laparoscopy group (68.18% versus 13.33%; P = .03). Conclusions: Compared with open gastrostomy, the laparoscopic approach appears to be advantageous with respect to procedural duration, initiation of feedings, hospitalization duration, and rate of complications. Another difference was the frequency of concomitant Nissen fundoplication. Further prospective studies may determine the role of these patient-specific factors regarding who benefits most from the laparoscopic technique.
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Affiliation(s)
- Yury Kozlov
- 1 Department of Neonatal Surgery, Municipal Pediatric Hospital, Irkutsk, Russia.,2 Department of Pediatric Surgery, Irkutsk State Medical Academy of Continuing Education (IGMAPO), Irkutsk, Russia.,3 Department of Pediatric Surgery, State Medical University, Irkutsk, Russia
| | - Vladimir Novozhilov
- 1 Department of Neonatal Surgery, Municipal Pediatric Hospital, Irkutsk, Russia.,2 Department of Pediatric Surgery, Irkutsk State Medical Academy of Continuing Education (IGMAPO), Irkutsk, Russia.,3 Department of Pediatric Surgery, State Medical University, Irkutsk, Russia
| | - Konstantin Kovalkov
- 4 Department of Pediatric Surgery, Municipal Pediatric Clinical Hospital, Kemerovo, Russia
| | - Andrey Rasputin
- 1 Department of Neonatal Surgery, Municipal Pediatric Hospital, Irkutsk, Russia
| | - Polina Baradieva
- 1 Department of Neonatal Surgery, Municipal Pediatric Hospital, Irkutsk, Russia
| | - Alexander Razumovsky
- 5 Department of Pediatric Surgery, Russian National Scientific Medical University, Moscow, Russia
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19
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Macchini F, Zanini A, Farris G, Morandi A, Brisighelli G, Gentilino V, Fava G, Leva E. Infant Percutaneous Endoscopic Gastrostomy: Risks or Benefits? Clin Endosc 2018; 51:260-265. [PMID: 29310429 PMCID: PMC5997076 DOI: 10.5946/ce.2017.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND/AIMS To present a single center's experience with percutaneous endoscopic gastrostomy (PEG) tube placement in infants. METHODS Clinical records of infants who underwent PEG tube placement between January 2010 and December 2015 were reviewed. All patients underwent an upper gastrointestinal contrast study and an abdominal ultrasonography before the procedure. PEGs were performed with a 6-mm endoscope using the standard pull-through technique. Data regarding gestational age, birth weight, age and weight, days to feeding start, days to full diet, and complications were reviewed. RESULTS Twenty-three patients were included. The most common indication was dysphagia related to hypoxic-ischemic encephalopathy. Median gestational age was 37 weeks (range, 24-41) and median birth weight was 2,605 grams (560-4,460). Patients underwent PEG procedures at a median age of 114 days (48-350); mean weight was 5.1 kg (3.2-8.8). In all patients but one, a 12-Fr tube was positioned. Median feeding start was 3 days (1-5) and on average full diet was achieved 5 days after the procedure (2-11). Six minor complications were recorded and effectively treated in the outpatient clinic; no major complications were recorded. CONCLUSIONS PEG is safe and feasible in infants when performed by highly experienced physicians.
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Affiliation(s)
- Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Zanini
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giorgio Farris
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giulia Brisighelli
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Valerio Gentilino
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giorgio Fava
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
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20
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Boonipat T, Adams NS, Shoemaker AL, Mann RJ, Polley JW, Girotto JA. Trends in Enteral Access Placement Among Patients With Oral Clefts: Evaluation of 46 617 Patient Admissions. Cleft Palate Craniofac J 2018; 56:21-30. [PMID: 29672164 DOI: 10.1177/1055665618771425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE It is well known that patients with oral clefts have challenges with feeding. Enteral feeding access, in the form of gastrostomy, is often utilized to supplement or replace oral intake. Although commonly performed, these procedures have reported complication rates as high as 83%. We intend to discover rates of enteral access in patients with oral clefts and report-related outcomes. DESIGN The Healthcare Cost Utilization Project Kids' Inpatient Database from 2000 to 2012 was analyzed using patients with oral clefts and enteral access procedures. The χ2 test was used for univariate analyses of proportions, and linear regression was used to analyze trends. Multivariate logistic regression was used to analyze odds ratios. RESULTS Of the 46 617 patient admissions included, 14.6% had isolated cleft lip (CL), 51.7% cleft lip and palate (CLP), and 43.7% isolated cleft palate. The rates of enteral access in the oral cleft population increased from 3.7% in 2000 to 5.8% in 2012 ( P < .001). Increased rates were identified in patients with ( P = .019) and without ( P < .001) complex conditions. A significant increase in the rate of enteral access was seen in patients with CLP ( P < .001) and isolated cleft palate ( P < .001). No difference was seen in the isolated CL group ( P = .096). Patients with complex conditions were at a 4.4-fold increased risk and those admitted to urban, teaching hospitals were at a 4.7-fold risk of enteral access placement. CONCLUSIONS The rates for enteral feeding access increased significantly from 2000 to 2012. The reasons for the increased incidence are unclear. Invasive enteral access procedures have been shown to have a multitude of complications. Careful patient selection should be done before placement of invasive enteral access.
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Affiliation(s)
- Thanapoom Boonipat
- 1 Mayo Clinic Plastic and Reconstructive Surgery Residency, Rochester, MN, USA
| | - Nicholas S Adams
- 2 Spectrum Health/Michigan State University Plastic Surgery Residency, Grand Rapids, MI, USA
| | | | - Robert J Mann
- 2 Spectrum Health/Michigan State University Plastic Surgery Residency, Grand Rapids, MI, USA.,4 Division of Pediatric Plastic Surgery and Dermatology, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - John W Polley
- 2 Spectrum Health/Michigan State University Plastic Surgery Residency, Grand Rapids, MI, USA.,4 Division of Pediatric Plastic Surgery and Dermatology, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
| | - John A Girotto
- 2 Spectrum Health/Michigan State University Plastic Surgery Residency, Grand Rapids, MI, USA.,4 Division of Pediatric Plastic Surgery and Dermatology, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
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21
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Hansen E, Qvist N, Rasmussen L, Ellebaek MB. Postoperative complications following percutaneous endoscopic gastrostomy are common in children. Acta Paediatr 2017; 106:1165-1169. [PMID: 28374507 DOI: 10.1111/apa.13865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/13/2017] [Accepted: 03/30/2017] [Indexed: 11/28/2022]
Abstract
AIM Inserting a feeding tube using percutaneous endoscopic gastrostomy may be necessary to ensure that children with eating problems receive sufficient enteral nutrition. The aim of this study was to investigate the perioperative and postoperative complications of percutaneous endoscopic gastrostomy when the pull-through method was the standard procedure. METHODS This was a retrospective review of 229 children (50.7% male) who underwent a gastrostomy procedure at Odense University Hospital, Denmark, from January 1, 2000 to December 31, 2012. The median age of the children was 1.6 years (range: 0-14.9), and the follow-up period was 36 months. Complications were graded according to the Clavien-Dindo classification. RESULTS A total of 167 postoperative complications occurred in 118 of the 229 patients (51.5%). Of these, 89 were grade 1 complications, 49 were grade 2 complications, and 29 were grade 3b complications. No gastrostomy-related deaths were observed, and no single preoperative risk factor was identified. Perioperative complications were experienced by 2.6% of the patients. CONCLUSION Gastrostomy feeding tube placement was associated with a high rate of postoperative complications of various grades when the pull-through method was the standard procedure. A consensus on how to report and grade complications arising from this procedure is warranted.
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Affiliation(s)
- E Hansen
- Department of Surgery; Odense University Hospital; Odense Denmark
| | - N Qvist
- Department of Surgery; Odense University Hospital; Odense Denmark
| | - L Rasmussen
- Department of Surgery; Odense University Hospital; Odense Denmark
| | - MB Ellebaek
- Department of Surgery; Odense University Hospital; Odense Denmark
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22
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Franken J, Mauritz FA, Stellato RK, Van der Zee DC, Van Herwaarden-Lindeboom MYA. The Effect of Gastrostomy Placement on Gastric Function in Children: a Prospective Cohort Study. J Gastrointest Surg 2017; 21:1105-1111. [PMID: 28424983 PMCID: PMC5486691 DOI: 10.1007/s11605-017-3376-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A gastrostomy placement is frequently performed in pediatric patients who require long-term enteral tube feeding. Unfortunately, postoperative complications such as leakage, feeding intolerance, and gastroesophageal reflux frequently occur. These complications may be due to postoperative gastric dysmotility. Our aim was to evaluate the effect of gastrostomy placement on gastric emptying in children. METHODS A prospective study was performed including 50 children undergoing laparoscopic gastrostomy. Before and 3 months after gastrostomy, assessment was performed using the 13C-octanoic acid breath test, 24-h pH monitoring, and reflux symptom questionnaires. RESULTS Gastric half-emptying time significantly increased from the 57th to the 79th percentile (p < 0.001) after gastrostomy (p < 0.001). Fifty percent of patients with normal preoperative gastric emptying develop delayed gastric emptying (DGE, P > 95) after gastrostomy (p = 0.01). Most patients (≥75%) with leakage and/or feeding intolerance after gastrostomy had DGE after operation. A decrease in gastric emptying was associated with an increase in esophageal acid exposure time (r = 0.375, p < 0.001). CONCLUSION Gastrostomy placement in children causes a significant delay in gastric emptying. Postoperative DGE was associated with gastroesophageal reflux and was found in most patients with postoperative leakage and feeding intolerance. These negative physiologic effects should be taken into account when considering gastrostomy placement in children.
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Affiliation(s)
- Josephine Franken
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
| | - Femke A Mauritz
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands
- Department of Gastroenterology and Hepatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Rebecca K Stellato
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David C Van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Maud Y A Van Herwaarden-Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands
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van Els AL, van Driel JJ, Kneepkens CMF, de Meij TGJ. Antibiotic prophylaxis does not reduce the infection rate following percutaneous endoscopic gastrostomy in infants and children. Acta Paediatr 2017; 106:801-805. [PMID: 28130790 DOI: 10.1111/apa.13762] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/18/2016] [Accepted: 01/24/2017] [Indexed: 12/29/2022]
Abstract
AIM Percutaneous endoscopic gastrostomy (PEG) is the standard for placing gastrostomy in children needing long-term enteral nutrition, with major and minor complications reported in up to 19% and 47.7% of children, respectively. We reviewed our experience with PEG, concentrating on the efficacy of antibiotic prophylaxis in reducing infectious complications. METHODS We performed a retrospective, single-centre study that comprised all children up to 18 years of age who underwent a first PEG procedure in the VU University Medical Centre, Amsterdam, from 2008 to 2012. All complications up to one month after PEG were recorded. Infection rates with and without antibiotic prophylaxis could be compared as a new protocol requiring the preprocedure administration of cefazolin was not followed consistently. RESULTS We enrolled 129 patients (78 male) with a mean age of 4.9 ± 4.8 years and median age of 2.9 years. Major complications were seen in seven patients (5.4%) and minor complications in 23 patients (17.8%). Antibiotic prophylaxis was administered to 99 of 129 children (76.7%). Infections occurred in 15 of 129 patients (11.6%); 14 of 99 with and 1 of 30 without prophylaxis developed infections (p = 0.106). Peristomal infections were the most frequent complication (10.1%). CONCLUSION Percutaneous endoscopic gastrostomy was a safe procedure and antibiotic prophylaxis did not seem to decrease infectious complications.
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Affiliation(s)
- Anne L. van Els
- Department of Paediatric Gastroenterology; VU University Medical Centre; Amsterdam The Netherlands
| | - J Joris van Driel
- Princess Amalia Children's Centre; Isala Hospital; Zwolle The Netherlands
| | - CM Frank Kneepkens
- Department of Paediatric Gastroenterology; VU University Medical Centre; Amsterdam The Netherlands
| | - Tim G. J. de Meij
- Department of Paediatric Gastroenterology; VU University Medical Centre; Amsterdam The Netherlands
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Gastrostomy Placement in Children: Percutaneous Endoscopic Gastrostomy or Laparoscopic Gastrostomy? Surg Laparosc Endosc Percutan Tech 2017; 26:381-384. [PMID: 27661204 PMCID: PMC5054954 DOI: 10.1097/sle.0000000000000310] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The aim of this study is to compare the outcomes and the complications between the 2 most adopted procedures for gastrostomy placement: percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) in children. We present our study on 69 patients (male: 46/female: 23): group 1 (37 patients, 54%) undergoing PEG, group 2 (32 patients, 46%) undergoing LG. A total of 5 major complications were observed all in the PEG group (13.5%), no major complication was observed in the LG group (P-value<0.05). A total of 12 minor complications were observed: 4 occurred in the PEG group (10.8%) and 8 (25%) in the laparoscopic gastrostmoy group, not statistically relevant. We suggest that the LG should be considered the preferred technique for gastrostomy placement in pediatric patients, particularly in newborns, children with significant skeletal malformations, and patients who underwent previous abdominal surgery.
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Chuah YY, Lee YY, Tsai TJ. An unexpected cause of transient diarrhea. Postgrad Med 2017; 129:488-490. [PMID: 28335674 DOI: 10.1080/00325481.2017.1311198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Migration of percutaneous endoscopic gastrostomy (PEG) tube to colon with gastro-colonic-cutaneous fistula formation is a rare complication of the procedure. Transient episodic diarrhea following each PEG tube feeding is typical of this complication. We present a 72-year-old man with cerebrovascular disease and scoliosis who encountered episodes of transient diarrhea after each PEG tube feeding. His diarrhea was refractory to medications. Colonoscopy demonstrated a mal-positioned PEG in the transverse colon. Computed tomogram (CT) of abdomen further confirmed the finding. After removal of the migrated PEG, his diarrhea had ceased completely. The gastro-colonic-cutaneous fistula was further managed with endoscopic clipping method with no complications encountered during follow up.
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Affiliation(s)
- Yoen Young Chuah
- a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.,b Division of Gastroenterology and Hepatology, Department of Internal Medicine , Ping Tung Christian Hospital , Ping Tung , Taiwan
| | - Yeong Yeh Lee
- c Department of Medicine, School of Medical Sciences , Universiti Sains Malaysia , Kubang Kerian , Kelantan , Malaysia
| | - Tzung Jiun Tsai
- a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan
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Yap BKY, Nah SA, Chen Y, Low Y. Fundoplication with gastrostomy vs gastrostomy alone: a systematic review and meta-analysis of outcomes and complications. Pediatr Surg Int 2017; 33:217-228. [PMID: 27889821 DOI: 10.1007/s00383-016-4028-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2016] [Indexed: 01/16/2023]
Abstract
PURPOSE We compare the outcomes of fundoplication with gastrostomy vs gastrostomy alone and review the need for subsequent fundoplication after the initial gastrostomy alone. METHODS We searched studies published from 1969 to 2016 for comparative outcomes of concomitant fundoplication with gastrostomy (FGT) vs gastrostomy insertion alone (GT) in children. Gastrostomy methods included open, laparoscopic, and endoscopic procedures. Primary aims were minor and major complications. Secondary aims included post-operative reflux-related complications, fundoplication specific complications, and need for subsequent fundoplication after GT. RESULTS We reviewed 447 studies; 6 observational studies were included for meta-analysis, encompassing 2730 children undergoing GT (n = 1745) or FGT (n = 985). FGT was associated with more minor complications [19.9 vs 11.4%, OR 2.02, 95% confidence interval (CI) 1.43-2.87, p ≤ 0.0001, I 2 = 0%], minor complications requiring revision (6.8 vs 3.0%, OR 2.27, 95% CI 1.28-4.05, p = 0.005, I 2 = 0%), and more overall complications (21.3 vs 12.0%, OR 1.99, 95% CI 1.43-2.78, p < 0.0001, I 2 = 0%). Incidence of major complications (1.8 vs 2.0%, OR 1.39, 95% CI 0.62-3.11, p = 0.42, I 2 = 5%) and reflux-related complications (8.8 vs 10.3%, OR 0.75, 95% CI 0.35-1.68, p = 0.46, I 2 = 0%) in both groups was similar. Incidence of subsequent fundoplication in GT patients was 8.6% (mean). CONCLUSIONS Gastrostomy alone is associated with fewer minor and overall complications. Concomitant fundoplication does not significantly reduce reflux-related complications. As few patients require fundoplication after gastrostomy, current evidence does not support concomitant fundoplication.
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Affiliation(s)
- Brendan K Y Yap
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Shireen Anne Nah
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Yong Chen
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Yee Low
- Department of Pediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
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Landisch RM, Colwell RC, Densmore JC. Infant gastrostomy outcomes: The cost of complications. J Pediatr Surg 2016; 51:1976-1982. [PMID: 27678507 DOI: 10.1016/j.jpedsurg.2016.09.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Comparative outcomes of enhanced percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) have not been elucidated in infants. We describe the outcomes and procedural episodic expenditures of PEG versus LG in this high-risk population. METHODS One hundred eighty-three gastrostomies in children under 1year were reviewed from our institution spanning 1/2011-6/2015. Pertinent demographics and 3-month complications (mortality, gastrocolic fistula, reoperation, cellulitis, granulation, pneumonia, and tube dislodgement <6weeks) were collected. Facility and professional administrative data was used to conduct a charge and cost analysis of PEG and LG procedures as well as their statistically significant complications. RESULTS Seventy-eight PEG and 105 LG infants were compared. LG infants were significantly younger, had higher ASA class, and increased frequency of cardiopulmonary disease. Significant major complications included a 3.8% incidence of gastrocolic fistula among PEGs (3.8% vs 0%, p=0.04) and 7.6% early tube dislodgements among LG infants (0 vs. 7.6%, p=0.01), resulting in $86,896 of additional charges with PEG complication. Incorporating complication frequency, average charges and variable cost per case were $8964 and $253 greater using PEG. CONCLUSIONS Despite a healthier cohort, infants undergoing enhanced PEG have more morbid and costly complications. LG may be the less burdensome approach to gastrostomy in infants. LEVEL OF EVIDENCE Case-Control Study/Retrospective Comparative Study - Level III.
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Affiliation(s)
- Rachel M Landisch
- Children's Research Institute and Children's Hospital of Wisconsin, Milwaukee, WI 53226; Medical College of Wisconsin, Milwaukee, WI 53226.
| | - Ryan C Colwell
- Children's Research Institute and Children's Hospital of Wisconsin, Milwaukee, WI 53226
| | - John C Densmore
- Children's Research Institute and Children's Hospital of Wisconsin, Milwaukee, WI 53226; Medical College of Wisconsin, Milwaukee, WI 53226
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A Silent and Chronic Complication of Percutaneous Endoscopic Gastrostomy Tube: Small Bowel Enterocutaneous Fistula. Case Rep Gastrointest Med 2016; 2016:5328240. [PMID: 27891266 PMCID: PMC5116343 DOI: 10.1155/2016/5328240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) has gradually gained the popularity since its invention and become the most preferred method for gastrostomy insertion in recent years. PEG is associated with lower morbidity and mortality and has the advantages of being minimally invasive and more convenient over the conventional open gastrostomy. However, significant rates of major complication still occur. Enterocutaneous fistula is one of the key complications that can be easily neglected due to its asymptomatic nature. We present a case of small bowel enterocutaneous fistula which was only found 8 years after the PEG insertion, being diagnosed after the longest duration of delay in diagnosis reported in literature.
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Kato K, Iwasaki Y, Onodera K, Matsuda M, Higuchi M, Kato K, Kato Y, Taniguchi M, Furukawa H. Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Combined with CT-GC. J INVEST SURG 2016; 30:193-200. [PMID: 27700181 DOI: 10.1080/08941939.2016.1232451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. MATERIALS AND METHODS In total, seven high-risk individuals diagnosed using computed tomography (CT)-gastrocolonography (GC) underwent laparoscopic-assisted PEG (LAPEG) placement. Study endpoints included the success of LAPEG under local anesthetic and intravenous sedation, inability to thread the PEG tube, the eventual tube location, the number of tube adjustments needed, adverse events, the operating time, and PEG tube-related infection. RESULTS In total, 135 PEG procedures were performed during this study. Successful CT-GC was achieved in all 135 patients, and we successfully used a standard PEG technique to place the gastrostomy tube in 128 patients (95%). In seven patients (5%), the LAPEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. LAPEG procedure-related minor complications were observed in two patients. CONCLUSIONS LAPEG combined with CT-GC can be used for patients with difficult anatomical orientations and may minimize the risk of complications in PEG placement.
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Affiliation(s)
- Kazuya Kato
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Yoshiaki Iwasaki
- b Department of Gastroenterology and Hepatology , Okayama University , Okayama , Japan
| | | | - Minoru Matsuda
- d Department of Surgery , Nihon University , Tokyo , Japan
| | - Mineko Higuchi
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Kimitaka Kato
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Yurina Kato
- e Department of Oral Surgery , Jikei University , Tokyo , Japan
| | - Masahiko Taniguchi
- f Department of Surgery , Asahikawa Medical University , Asahikawa , Japan
| | - Hiroyuki Furukawa
- f Department of Surgery , Asahikawa Medical University , Asahikawa , Japan
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Tringali A, Balassone V, De Angelis P, Landi R. Complications in pediatric endoscopy. Best Pract Res Clin Gastroenterol 2016; 30:825-839. [PMID: 27931639 DOI: 10.1016/j.bpg.2016.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/17/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023]
Abstract
The experience of the "endoscopic community" in pediatric patients is limited, but during recent years increased skills of the endoscopists and technological improvements lead to a standardization of pediatric endoscopy and the development of specialized pediatric endoscopy unit. Adverse events related to diagnostic and therapeutic endoscopy in children are usually rare. Diagnosis, prevention and treatment of complications in pediatric endoscopy is crucial when dealing with benign diseases in children. The complication rate of diagnostic EGD and colonoscopy in children are extremely low. Therapeutic procedures have obviously an increased rate of adverse events. Esophageal dilations are the most common indication for endoscopic therapy in children and can lead to perforations which requires prompt diagnosis and management. Complications of ERCP in pediatric age are similar to those reported in adults. The experience in pediatric emergency endoscopy (mainly foreign body removal) is consolidated and related adverse events extremely rare. Sedation of children during endoscopy maybe needs further evaluation and standardization, to reduce the rate of specific complications.
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Affiliation(s)
| | - Valerio Balassone
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.
| | - Paola De Angelis
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy.
| | - Rosario Landi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy.
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Khalil ST, Uhing MR, Duesing L, Visotcky A, Tarima S, Nghiem-Rao TH. Outcomes of Infants With Home Tube Feeding: Comparing Nasogastric vs Gastrostomy Tubes. JPEN J Parenter Enteral Nutr 2016; 41:1380-1385. [PMID: 27647478 DOI: 10.1177/0148607116670621] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to determine the tube-related complications and feeding outcomes of infants discharged home from the neonatal intensive care unit (NICU) with nasogastric (NG) tube feeding or gastrostomy (G-tube) feeding. MATERIALS AND METHODS We performed a chart review of 335 infants discharged from our NICU with home NG tube or G-tube feeding between January 2009 and December 2013. The primary outcome was the incidence of feeding tube-related complications requiring emergency department (ED) visits, hospitalizations, or deaths. Secondary outcome was feeding status at 6 months postdischarge. Univariate and multivariate analyses were conducted. RESULTS There were 322 infants discharged with home enteral tube feeding (NG tube, n = 84; G-tube, n = 238), with available outpatient data for the 6-month postdischarge period. A total of 115 ED visits, 28 hospitalizations, and 2 deaths were due to a tube-related complication. The incidence of tube-related complications requiring an ED visit was significantly higher in the G-tube group compared with the NG tube group (33.6% vs 9.5%, P < .001). Two patients died due to a G-tube-related complication. By 6 months postdischarge, full oral feeding was achieved in 71.4% of infants in the NG tube group compared with 19.3% in the G-tube group ( P < .001). Type of feeding tube and percentage of oral feeding at discharge were significantly associated with continued tube feeding at 6 months postdischarge. CONCLUSION Home NG tube feeding is associated with fewer ED visits for tube-related complications compared with home G-tube feeding. Some infants could benefit from a trial home NG tube feeding.
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Affiliation(s)
- Syed Tariq Khalil
- 1 Division of Neonatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael R Uhing
- 1 Division of Neonatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lori Duesing
- 2 Division of Pediatric Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alexis Visotcky
- 3 Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sergey Tarima
- 3 Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - T Hang Nghiem-Rao
- 1 Division of Neonatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Does Gastrostomy Placement With Concurrent Fundoplication Increase the Risk of Gastrostomy-related Complications? J Pediatr Gastroenterol Nutr 2016; 63:29-33. [PMID: 26650105 DOI: 10.1097/mpg.0000000000001063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE To compare the incidence of complications with a primary gastrostomy versus gastrostomy with concurrent fundoplication and evaluating the impact of the method of gastrostomy tube placement. Neurologically impaired children were compared with neurologically normal children. Two low profile devices were compared for longevity. METHODS Ninety-eight patients (58 boys, mean age 4.66 years) with 107 gastrostomies inserted between April 2004 and May 2008 were included in this retrospective, single institution audit. Minimum follow-up period was 1 year. Specific complications reviewed were tube and site related. Logistic regression analysis examined the relationship between complications, type of procedure, method of placement, and neurological status. Survival analysis with log-rank test was used to compare the duration of the low-profile devices. RESULTS There were 63 primary gastrostomies and 44 with concurrent fundoplication, 71 children were neurologically impaired. Mean (±SD) follow-up time was 35.6 ± 1.4 months. There was a significant association between concurrent gastrostomy insertion with fundoplication and incidence of infection (odds ratio = 2.4, 95% confidence interval (CI) 1.02-5.56, P = 0.02) and excoriation (odds ratio = 2.5, 95% CI 1.09-5.71, P = 0.015). There were no associations between the complications with gastrostomy placement and neurological status. Failure rate of the balloon device was significantly greater than the fixed bolster device with a Hazard Ratio for survival of 3.2 (95% CI 2.2-4.6). CONCLUSIONS Gastrostomy site-related problems were more common than generally reported. There was a higher incidence of site infection and skin excoriation for gastrostomy placement with concurrent fundoplication. There was no significant difference in complications between the method of gastrostomy placement or neurological status. Balloon devices were changed 3 times more often than bolster retention devices.
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Al-Jazaeri A, Al-Dekhayel M, Al-Saleh N, Al-Turki A, Al-Dhaheri M, Khan S. Guided Transabdominal U-Stitches Gastropexy: A Simplified Technique for Secure Laparoscopic Gastrostomy Tube Insertion. J Laparoendosc Adv Surg Tech A 2016; 30:228-232. [PMID: 26953774 DOI: 10.1089/lap.2015.0263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Insecure gastropexy, gastric mucosa overgrowth, granulation tissue formation, and a nonhealing gastrostomy are unwanted consequences encountered in the current minimally invasive gastrostomy tube (GT) placement techniques. Aiming to overcome these problems we have developed a simplified laparoscopic-assisted GT insertion (LAG) procedure using guided transabdominal U-stitches (GTU) gastropexy. Materials and Methods: We retrospectively reviewed all LAG cases performed in our institute using the GTU technique. In brief, a curved clamp is inserted intragastrically through the laparoscopic port and guides a needle across the abdominal and gastric walls to exit, then re-enter back, through the port in an out-in-out fashion creating multiple spaced transabdominal U-stitches that are tied over pledgets. Results: Between March 2008 and January 2015, 31 cases had LAG attempted using GTU. Two cases were converted to open procedures for non-LAG-related reasons. The median age of the remaining 29 cases was 37 (range, 0.3-154.9) months. Of those patients, 20 had fundoplication (LAG-Fundo), whereas the remaining 9 had LAG-only. The mean operative times for LAG-Fundo and LAG-only were 148 ± 57.5 minutes and 41 ± 12.4 minutes, respectively. During a median follow-up of 21 (range, 4-81) months we did not encounter any procedure-related mortality, intraabdominal leaks, or bowel injuries. One patient required redo gastropexy due to unplanned early U-stitch removal, and 7 cases had transient external GT leak, granuloma formation, and/or skin infection. Conclusions: GTU can achieve a simple and secure LAG, avoiding the catastrophic complications of intraabdominal leak without the need of special instruments or enlarging the port's wound. Using a smaller wound and intraabdominally placed mucosa helps in minimizing the risk of wound infection and external leak. Transient complications are expected during the earlier phase of the learning curve.
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Affiliation(s)
- Ayman Al-Jazaeri
- Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mosaed Al-Dekhayel
- Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nasser Al-Saleh
- Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Al-Turki
- Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Al-Dhaheri
- Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saifullah Khan
- Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Suksamanapun N, Mauritz FA, Franken J, van der Zee DC, van Herwaarden-Lindeboom MY. Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis. J Minim Access Surg 2016; 13:81-88. [PMID: 27251841 PMCID: PMC5363129 DOI: 10.4103/0972-9941.181776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) and laparoscopic-assisted gastrostomy (LAG) are widely used in the paediatric population. The aim of this study was to determine which one of the two procedures is the most effective and safe method. METHODS: This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement. Primary outcomes were success rate, efficacy of feeding, quality of life, gastroesophageal reflux and post-operative complications. RESULTS: Five retrospective studies, comparing 550 PEG to 483 LAG placements in children, were identified after screening 2347 articles. The completion rate was similar for both procedures. PEG was associated with significantly more adjacent bowel injuries (P = 0.047), early tube dislodgements (P = 0.02) and complications that require reintervention under general anaesthesia (P < 0.001). Minor complications were equally frequent after both procedures. CONCLUSIONS: Because of the lack of well-designed studies, we have to be cautious in making definitive conclusions comparing PEG to LAG. To decide which type of gastrostomy placement is best practice in paediatric patients, randomised controlled trials comparing PEG to LAG are highly warranted.
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Affiliation(s)
- Nutnicha Suksamanapun
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Femke A Mauritz
- Department of Pediatric Surgery, Wilhelmina Children's Hospital; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Josephine Franken
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Abstract
Placement of gastrostomy tubes in infants and children has become increasingly commonplace. A historical emphasis on use of open gastrostomy has been replaced by less invasive methods of placement, including percutaneous endoscopic gastrostomy and laparoscopically assisted gastrostomy procedures. Various complications, ranging from minor to the more severe, have been reported with all methods of placement. Many pediatric patients who undergo gastrostomy tube placement will require long-term enteral therapy. Given the prolonged time pediatric patients may remain enterally dependent, further quality improvement and education initiatives are needed to improve long-term care and outcomes of these patients.
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Affiliation(s)
- Maireade E McSweeney
- Division of Gastroenterology and Nutrition, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - C Jason Smithers
- Department of General Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Kozlov Y, Novozhilov V, Kovalkov KA. Comparison of Two Laparoscopic Techniques for Gastropexy in Children. J Laparoendosc Adv Surg Tech A 2015; 25:1057-62. [PMID: 26583591 DOI: 10.1089/lap.2015.0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Laparoscopic gastrostomy is a widely used interventional procedure in pediatric surgery. We report comparative data for two endosurgical methods for the fixation of the stomach against the abdominal wall, using the U-stitches technique and the Saf-T-Pexy® (Halyard Health Inc., Alpharetta, GA) system. MATERIALS AND METHODS Within the period from January 2012 to June 2014 we performed 24 operations involving laparoscopic placement of a gastrostomy tube using U-stitches (Group I) and 24 operations using the Saf-T-Pexy system (Group II). The two groups of patients were compared in terms of demographics and intraoperative and postoperative results. RESULTS No statistical difference (P > .05) was found while comparing the patients' demographics and intra- and postoperative results. The mean duration of the surgical procedure in Group I was 23.75 minutes; in contrast, the mean duration of surgery in Group II was 22.71 minutes (P > .05). The time to first feeding (9.96 hours versus 10.63 hours) and time to full enteral feeding (23.13 hours versus 24.5 hours) were consistent for patients from both groups (P > .05). A similar postoperative duration of stay was recorded for the patients from the comparison groups (7.25 days versus 7.21 days; P > .05). Statistical analysis of the two groups demonstrated a significant difference in the parameters of minor postoperative complications (41.67% versus 8.33%; P < .05). CONCLUSIONS Use of the Saf-T-Pexy system is a simple and efficient method for gastropexy involving placement of gastrostomy tubes that significantly reduces the number of postoperative complications.
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Affiliation(s)
- Yury Kozlov
- 1 Department of Neonatal Surgery, Municipal Pediatric Hospital , Irkutsk, Russia .,2 Department of Pediatric Surgery, Irkutsk State Medical Academy of Continuing Education , Irkutsk, Russia
| | - Vladimir Novozhilov
- 1 Department of Neonatal Surgery, Municipal Pediatric Hospital , Irkutsk, Russia .,2 Department of Pediatric Surgery, Irkutsk State Medical Academy of Continuing Education , Irkutsk, Russia .,3 Department of Pediatric Surgery, Irkutsk State Medical University , Irkutsk, Russia
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Affiliation(s)
| | - Vi Lier Goh
- Department of Pediatrics, Boston University Medical Center, Boston, Massachusetts
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Preliminary Results of Percutaneous Radiologic Gastrostomy in a Pediatric Population: A Modified Chiba-Needle Puncture Technique With Single Gastropexy. AJR Am J Roentgenol 2015; 205:W133-7. [DOI: 10.2214/ajr.14.12543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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McSweeney ME, Kerr J, Jiang H, Lightdale JR. Risk factors for complications in infants and children with percutaneous endoscopic gastrostomy tubes. J Pediatr 2015; 166:1514-9.e1. [PMID: 25868432 DOI: 10.1016/j.jpeds.2015.03.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/26/2015] [Accepted: 03/04/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To identify risk factors associated with percutaneous endoscopic gastrostomy (PEG) tube complications in a large cohort of infants and children. STUDY DESIGN We performed a chart review of 591 pediatric patients undergoing PEG tube placement between 2006 and 2010 at Boston Children's Hospital. Frequency and type of major and minor complications associated with PEG tubes in children were identified. Univariate and multivariate analyses were then conducted to determine potential risk factors for complications. RESULTS A total of 198 PEG-related complications (72 major and 126 minor) were noted in our cohort of 591 patients. Approximately 10.5% of patients experienced at least one major complication and 16.4% experienced at least one minor complication, with the great majority of complications occurring after discharge postplacement. Age <6 months (P = .003), American Society of Anesthesiologists class III (P = .02), and presence of a neurologic disorder (P = .05) were found to be protective against experiencing a major complication, whereas the presence of a ventriculoperitoneal shunt was confirmed to be a risk factor (P = .01) for major complications. CONCLUSION Both minor and major complications are common in children after PEG tube placement, with most complications occurring several months postoperatively. Certain patient factors, including age, neurologic status, and American Society of Anesthesiologists class, may be protective, and the presence of a ventriculoperitoneal shunt may be associate with an increased risk of complications after PEG tube placement.
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Affiliation(s)
- Maireade E McSweeney
- Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - Jessica Kerr
- Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Hongyu Jiang
- Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jenifer R Lightdale
- Pediatric Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, Worcester, MA
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Computed tomography-gastro-colonography for percutaneous endoscopic gastrostomy using a helical computed tomography. Am J Surg 2015; 210:374-81. [PMID: 25912624 DOI: 10.1016/j.amjsurg.2014.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/04/2014] [Accepted: 10/11/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. METHODS In total, 48 individuals underwent computed tomography-gastro-colonography (CT-GC)-guided PEG placement. Study end points included success of CT-GC, inability to thread the PEG tube, the eventual tube location, tube adjustments needed, adverse events, operating time, and PEG tube-related infection. RESULTS A successful CT-GC was achieved in all 48 patients (100%), and we successfully used a standard PEG technique to place the gastrostomy tube in 44 patients (92%). In 4 patients (8%), the laparoscopic-assisted PEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. The overall procedure-related minor complication rate was 8%. CONCLUSION CT-GC is an optional method for the estimation of intra-abdominal, anatomical orientations that may minimize the risk of complications before PEG placement.
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Kozlov IA, Novozhilov VA, Rasputin AA, Us GP, Kuznetsova NN. [Button gastrostomy in children]. Khirurgiia (Mosk) 2015:48-53. [PMID: 25909552 DOI: 10.17116/hirurgia2015148-53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
For the period January 2002 to December 2013 it was performed 84 interventions for introduction of gastrostomy tube. The first group included 24 open operations and the second group had 60 laparoscopic operations by using of button devices MIC-KEY (Kimberly-Clark, Roswell, USA) in neonates and infants. Statistically significant difference was not observed during comparison of demographic data of patients. Differences in groups were found in statistical analysis of intra- and postoperative parameters (p<0.05). Mean duration of surgery in the first group was 37.29 min, in the second group - 23.97 min. Time to start of feeding and transition to complete enteral nutrition was less in patients who underwent laparoscopic surgery than after open intervention (10.5 and 19.13 hours, 23.79 and 35.88 hours respectively; p<0.05). It was revealed augmentation of hospital stay in the 1st group in comparison with the 2(nd) group (11.71 and 7.09 days respectively; p<0.05). Frequency of postoperative complications was 18.33% in the 2(nd) group and 24% - in the 1st group (p<0.05). The authors consider that button devices are simply and effective technique of gastrostomy establishment in children. It is associated with minimal surgery duration and allows to start early enteral nutrition in comparison with open techniques.
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Affiliation(s)
- Iu A Kozlov
- Tsentr khirurgii i reanimatsii novorozhdennykh Gorodskoĭ Ivano-Matreninskoĭ detskoĭ klinicheskoĭ bol'nitsy, Irkutsk; Kafedra detskoĭ khirurgii Irkutskoĭ gosudarstvennoĭ meditsinskoĭ akademii poslediplomnogo obrazovaniia
| | - V A Novozhilov
- Tsentr khirurgii i reanimatsii novorozhdennykh Gorodskoĭ Ivano-Matreninskoĭ detskoĭ klinicheskoĭ bol'nitsy, Irkutsk; Kafedra detskoĭ khirurgii Irkutskogo gosudarstvennogo meditsinskogo universiteta; Kafedra detskoĭ khirurgii Irkutskoĭ gosudarstvennoĭ meditsinskoĭ akademii poslediplomnogo obrazovaniia
| | - A A Rasputin
- Tsentr khirurgii i reanimatsii novorozhdennykh Gorodskoĭ Ivano-Matreninskoĭ detskoĭ klinicheskoĭ bol'nitsy, Irkutsk
| | - G P Us
- Tsentr khirurgii i reanimatsii novorozhdennykh Gorodskoĭ Ivano-Matreninskoĭ detskoĭ klinicheskoĭ bol'nitsy, Irkutsk
| | - N N Kuznetsova
- Tsentr khirurgii i reanimatsii novorozhdennykh Gorodskoĭ Ivano-Matreninskoĭ detskoĭ klinicheskoĭ bol'nitsy, Irkutsk
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Viktorsdóttir MB, Óskarsson K, Gunnarsdóttir A, Sigurdsson L. Percutaneous Endoscopic Gastrostomy in Children: A Population-Based Study from Iceland, 1999–2010. J Laparoendosc Adv Surg Tech A 2015; 25:248-51. [DOI: 10.1089/lap.2014.0296] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Kristján Óskarsson
- Department of Pediatric Surgery, Astrid Lindgren Children Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Gunnarsdóttir
- Department of Pediatric Surgery, Astrid Lindgren Children Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Pediatric Surgery, Landspitali University Hospital, Reykjavík, Iceland
| | - Luther Sigurdsson
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin—Madison, Madison, Wisconsin
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Birck MM, Vegge A, Moesgaard SG, Eriksen T. Single port laparoscopic long-term tube gastrostomy in Göttingen minipigs. Lab Anim 2014; 49:220-7. [DOI: 10.1177/0023677214562097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oral dosing by gavage is often used to test compounds in minipigs. This method is also used for certain nutritional studies that require exact dosing. This procedure may be stressful for the animal and requires the assistance of more than one technician. We investigated whether a gastrostomy tube could be placed and maintained in Göttingen minipigs using a single port laparoscopic technique. As part of another study, laparoscopic gastrostomy tube placement was performed in 12 Göttingen minipigs (32 ± 2 kg) under general anesthesia. The procedure involved single port laparoscopic visualization of the stomach and placement of a locking pigtail catheter into the fundus region of the stomach. The minipigs were followed for three weeks after surgery and macroscopic and microscopic tissue reactions were evaluated at necropsy. All catheters were successfully placed and were easy to use. At necropsy it was evident that the catheter had entered the stomach in the fundus region in 11/12 of the animals. In one animal the catheter had entered the antrum region. None of the animals developed leakage or clinically detectable reactions to the gastrostomy tube. Histopathologically, only discrete changes were observed. Single port laparoscopic tube gastrostomy with a locking pigtail catheter is safe, simple and reliable and is an appropriate alternative to, for example, percutaneous endoscopic gastrostomy, when long-term enteral delivery of pharmacological or nutritional compounds is needed. The use of the gastrostomy tube was easy and, based on subjective assessment, feeding was minimally stressful to the animals.
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Affiliation(s)
- MM Birck
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - A Vegge
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
- Diabetes Pharmacology, Novo Nordisk A/S, Måløv, Denmark
| | - SG Moesgaard
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
- Biopharm Toxicology and Safety Pharmacology, Novo Nordisk A/S, Måløv, Denmark
| | - T Eriksen
- Department of Veterinary Clinical and Animal Science, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Gang MH, Kim JY. Short-Term Complications of Percutaneous Endoscopic Gastrostomy according to the Type of Technique. Pediatr Gastroenterol Hepatol Nutr 2014; 17:214-22. [PMID: 25587521 PMCID: PMC4291446 DOI: 10.5223/pghn.2014.17.4.214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 10/13/2014] [Accepted: 10/17/2014] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The method of percutaneous endoscopic gastrostomy (PEG) tube placement can be divided into the pull and introducer techniques. We compared short-term complications and prognosis between patients who underwent the pull technique and two other types of introducer techniques, the trocar introducer technique and T-fastener gastropexy technique. METHODS Twenty-six patients who underwent PEG were enrolled in this study. We retrospectively investigated the age, sex, body weight, weight-for-age Z-score, underlying diseases, PEG indications, complications, duration of NPO (nil per os), pain control frequency, and duration of antibiotic therapy. The patients were classified into three groups according to the PEG technique. The occurrence of complications was monitored for 10 weeks after the procedure. RESULTS The age, sex, body weight, and weight-for-age Z-score were not significantly between the three groups. Most patients had cerebral palsy and seizure disorders. Dysphagia was the most common indication for PEG. Major complications occurred in 5 (50%), 4 (66.7%), and 0 (0%) patients in group I, II, and III, respectively (p=0.005). Further, peristomal infection requiring systemic antibiotic therapy occurred in 2 (20%), 3 (50%), and 0 (0%) patients in group I, II, and III, respectively (p=0.04). There was no significant difference between the groups with respect to minor complications, duration of NPO, pain control frequency, and duration of antibiotic therapy. CONCLUSION The results indicate that the T-fastener gastropexy technique was associated with the lowest rate of major complications.
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Affiliation(s)
- Mi Hyeon Gang
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae Young Kim
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
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Pre- and postoperative vomiting in children undergoing video-assisted gastrostomy tube placement. Surg Res Pract 2014; 2014:871325. [PMID: 25379563 PMCID: PMC4208457 DOI: 10.1155/2014/871325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/12/2014] [Accepted: 08/04/2014] [Indexed: 11/17/2022] Open
Abstract
Background. The aim of this study was to determine the incidence of pre- and postoperative vomiting in children undergoing a Video-Assisted Gastrostomy (VAG) operation. Patients and Methods. 180 children underwent a VAG operation and were subdivided into groups based on their underlying diagnosis. An anamnesis with respect to vomiting was taken from each of the children's parents before the operation. After the VAG operation, all patients were followed prospectively at one and six months after surgery. All complications including vomiting were documented according to a standardized protocol. Results. Vomiting occurred preoperatively in 51 children (28%). One month after surgery the incidence was 43 (24%) in the same group of children and six months after it was found in 40 (22%). There was a difference in vomiting frequency both pre- and postoperatively between the children in the groups with different diagnoses included in the study. No difference was noted in pre- and postoperative vomiting frequency within each specific diagnosis group. Conclusion. The preoperative vomiting symptoms persisted after the VAG operation. Neurologically impaired children had a higher incidence of vomiting than patients with other diagnoses, a well-known fact, probably due to their underlying diagnosis and not the VAG operation. This information is useful in preoperative counselling.
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Franken J, Mauritz FA, Suksamanapun N, Hulsker CCC, van der Zee DC, van Herwaarden-Lindeboom MYA. Efficacy and adverse events of laparoscopic gastrostomy placement in children: results of a large cohort study. Surg Endosc 2014; 29:1545-52. [DOI: 10.1007/s00464-014-3839-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 08/19/2014] [Indexed: 11/28/2022]
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Lalanne A, Gottrand F, Salleron J, Puybasset-Jonquez AL, Guimber D, Turck D, Michaud L. Long-term outcome of children receiving percutaneous endoscopic gastrostomy feeding. J Pediatr Gastroenterol Nutr 2014; 59:172-6. [PMID: 24709828 DOI: 10.1097/mpg.0000000000000393] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of the present study was to analyze the long-term follow-up of children receiving percutaneous endoscopic gastrostomy (PEG) in terms of survival, nutritional outcome, and weaning from enteral nutrition. The secondary objectives were to evaluate the complications related to PEG and the outcome of patients with neurological disability. METHODS The present study was a single-center retrospective study including all of the 368 patients who underwent PEG from 1990 to 2003 in our tertiary hospital. RESULTS A total of 368 patients received PEG during the study period. After a median follow-up of 2.4 years (interquartile range 1.4-4.2 years), PEG was in place in 36% and was removed in 27%; 26% of patients were deceased. Two deaths could be directly related to PEG. A statistically significant weight and height catch-up was observed in patients with PEG in place in whom weight/age z score increased from -2.6 to -1.7 (P < 0.01) and height/age z score also increased from -2.1 to -1.6 (P < 0.01). In patients who had their PEG removed weight/age z score increased from -2.5 to -1.6 (P < 0.01) and height/age z score from -2.8 to -1.4 (P = 0.01) at the time of weaning. Early complications occurred in 152 patients, whereas late complications occurred in 191 patients. Most complications were minor (85%). After multivariate analyses, the factors associated with late complications were digestive and ear, nose, and throat (ENT) diseases, age <1 year at the time of PEG placement, and use of PEG longer than 2 years. Early complications were less frequent in patients with respiratory diseases. CONCLUSIONS PEG allows nutritional and growth catch-up and is safe in the long term.
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Affiliation(s)
- Arnaud Lalanne
- *Reference Centre for Congenital and Malformative Esophageal Diseases, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Faculty of Medicine and Jeanne de Flandre Children's Hospital, Lille University †Department of Biostatistics, CHRU Lille, University of Lille Nord de France, Lille, France
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Single-center experience with 1-step low-profile percutaneous endoscopic gastrostomy in children. J Pediatr Gastroenterol Nutr 2014; 58:616-20. [PMID: 24378575 DOI: 10.1097/mpg.0000000000000291] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The 1-step low-profile percutaneous endoscopic gastrostomy (1-step PEG) uses a single procedure that allows immediate use of a low-profile device. The aim of the present study was to provide our experience with this device and to analyze complications and outcomes after the initial placement. METHODS We performed a retrospective chart review of pediatric patients with 1-step PEG placement done by our pediatric gastroenterologists between 2006 and June 2011. Patients were studied for a minimum period of 6 months. RESULTS A total of 121 patients were included in our study, with 23% infants. The most common indication for 1-step PEG placement was swallowing dysfunction in children with neurological impairment (49%). Postplacement complications included granulation tissue (52%), cellulitis (23%), leakage (21%), vomiting (17%), tissue breakdown (8%), failed placement (6%), embedded bolster (5%), perforation (0.8%), and bowel obstruction (0.8%). One-step PEG was maintained in 46 patients (38%). In the remaining 75 patients (62%), PEGs were changed to a balloon device in 66 patients and were completely removed in 9 patients. The most common indications for change were damaged PEG (19/75) and issues with size (11/75). The time to change ranged from <1 month to >4 years (14 ± 1.3 months). Sixty-eight percent of 1-step PEG changes/removal was performed with an obturator under brief inhalated anesthesia. CONCLUSIONS The 1-step PEG has complication rates and outcomes comparable with standard PEGs.
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Lee HJ, Choung RS, Park MS, Pyo JH, Kim SY, Hyun JJ, Jung SW, Koo JS, Lee SW, Choi JH. Two cases of uncommon complication during percutaneous endoscopic gastrostomy tube replacement and treatment. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 63:120-4. [PMID: 24561699 DOI: 10.4166/kjg.2014.63.2.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We presented two interesting cases of gastrocolocutaneous fistula that occurred after percutaneous endoscopic gastrostomy (PEG) tube placement, and its management. This fistula is a rare complication that occurs after PEG insertion, which is an epithelial connection between mucosa of the stomach, colon, and skin. The management of the fistula is controversial, ranging from conservative to surgical intervention. Endoscopists should be aware of the possibility of gastrocolocutaneous fistula after PEG insertion, and should evaluate the risk factors that may contribute to the development of gastrocolocutaneous fistula before the procedure. We reviewed complications of gastrostomy tube insertion, symptoms of gastrocolocutaneous fistula, and its risk factors.
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Affiliation(s)
- Hyun Joo Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, 123 Jeokgeumro, Danwon-gu, Ansan 425-707, Korea
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Rollins H, Nathwani N, Morrison D. Optimising wound care in a child with an infected gastrostomy exit site. ACTA ACUST UNITED AC 2013; 22:1275-9. [DOI: 10.12968/bjon.2013.22.22.1275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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