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Gastrostomy Placement and Management in Children: A Single-Center Experience
Grazia Di Leo1, Paola Pascolo2, Kamar Hamadeh3
1Pediatric Gastroenterology, Endoscopy and Nutrition Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria 65/1, 34137 Trieste, Italy.
Insights
Gastrostomy tubes improve nutrition and reduce respiratory infections in children with neuromuscular disorders, with a low risk of complications and high parental satisfaction. This study evaluated outcomes in pediatric patients receiving gastrostomy feeding tubes.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Surgery
- Neurology
Background:
- Enteral nutrition via gastrostomy is crucial for managing malnutrition and aspiration in children with chronic neuromuscular conditions.
- While data on PEG complications exist, comprehensive series addressing all aspects are limited.
Purpose of the Study:
- To evaluate outcomes after gastrostomy tube placement in pediatric patients.
- To assess surgical complications, nutritional status, pulmonary infection prevention, and parental satisfaction.
Main Methods:
- Retrospective study of pediatric patients (<18 years) who underwent gastrostomy placement between 2003 and 2017.
- Analysis of early and late surgical complications, nutritional status changes, respiratory infection rates, and parental feedback.
Main Results:
- Eighty-four gastrostomies were placed, primarily for severe dysphagia in patients with severe neurocognitive impairment (GMFCS 5).
- Low rates of early (5.9%) and late (17.8%) surgical complications were observed; no gastrostomy-related deaths occurred.
- Significant improvements in nutritional status and reductions in respiratory infections and hospitalizations were noted. Parental satisfaction was high (90%).
Conclusions:
- Gastrostomy tube placement is associated with positive nutritional outcomes and reduced respiratory infections in children with neuromuscular disorders.
- The procedure carries a small risk of surgical complications, but parental experiences are generally very positive.
Background:
To prevent malnutrition and food aspiration in children with chronic neuromuscular problems, enteral nutrition provided by gastrostomy is recommended. Long-term follow-up data about surgical and medical complications of PEG are available, but few papers have addressed all of the issues in the same series.
Methods:
This retrospective study enrolled patients under 18 years who had a gastrostomy tube placed at our institution between 2003 and 2017. The aim is to evaluate outcomes after gastrostomy placement, focusing both on surgical complications (early and late), and its effect on their nutritional status, on the prevention of pulmonary infections, and their parents' opinion.
Results:
Eighty-four gastrostomies were placed in total (35 F; 49 M). Seventy-seven patients had a severe neurocognitive impairment (GMFCS 5). The principal indication for gastrostomy was severe dysphagia (53.3%). No gastrostomy-related death was observed. Early surgical complications were observed in five of 84 (5,9%) patients; late complications were observed in 15 of 84 (17.8%) patients. Twenty-two patients were diagnosed with subsequent gastroesophageal reflux; five patients developed dumping syndrome (6%). Complete medical follow-up data were available for 45 patients. A progressive improvement of nutritional status was observed in 29 patients, and 11 maintained the same percentile; the occurrence of respiratory infections and need for hospitalization decreased. In 90% of cases, parents were fully satisfied with the g-tube.
Conclusion:
This study confirms the positive nutritional outcomes of gastrostomy-tube with an associated small risk of surgical complications and a reduction in the number of respiratory infections, with most parents scoring their experience as positive.
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