Preoperative Evaluation Is Not Predictive of Transpyloric Feeding Conversion in Gastrostomy-dependent Pediatric...

Area of Science:

• Pediatric Gastroenterology
• Medical Device Engineering

Background:

• Gastrostomy (GT) tubes are common for pediatric feeding, but some patients require conversion to gastrojejunostomy (GJ) tubes for improved feeding tolerance or management.
• Predicting which patients will need GJ tube conversion based on preoperative evaluations is not well-established.

Purpose of the Study:

• To compare preoperative patient characteristics and diagnostic evaluations between pediatric patients maintained on GT feeds and those who required conversion to GJ feeds.
• To determine if preoperative assessments can identify patients likely to need GJ tube feeding.

Main Methods:

• Retrospective review of pediatric patients at Boston Children's Hospital who underwent GT placement and subsequent GJ conversion between 2006 and 2012.
• Matching GT patients with GJ-converted patients based on age, neurologic, and cardiac status.
• Review of preoperative characteristics, total hospitalizations, and respiratory admissions.

Main Results:

• No significant differences were observed in the rates of successful preoperative nasogastric feeding trials, upper gastrointestinal series, abnormal videofluoroscopic swallow studies, or gastric emptying studies between the GT and GJ groups.
• Preoperative hospitalization rates and respiratory admissions were similar between the two groups.
• Patients converted to GJ tubes experienced a significant mean reduction of 1.5 hospital admission days post-conversion.

Conclusions:

• Preoperative patient characteristics and diagnostic evaluations do not reliably predict the need for GJ tube conversion in pediatric patients initially placed on GT tubes.
• Conversion to GJ tubes in pediatric patients is associated with a significant decrease in overall hospital admissions, suggesting improved clinical outcomes.