Gastrostomy Tube Use in Pediatrics: A Systematic Review

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Clinical Guidelines

Background:

• Gastrostomy placement in children has variable techniques and limited patient-centered outcome data.
• Existing literature lacks consensus on optimal preoperative work-up and procedural methods for pediatric gastrostomy.

Purpose of the Study:

• To summarize current literature on pediatric gastrostomy procedures.
• To provide consensus-driven guidelines for enteral access decision-making in children.

Main Methods:

• Systematic review of PubMed, Google Scholar, Medline, and Scopus using keywords: "gastrostomy," "g-tube," and "tube feeding" in children.
• Evidence review with multidisciplinary stakeholder involvement adhering to GRADE methodology.
• Extraction of data, evidence levels, and risk of bias from 58 influencing publications.

Main Results:

• A trial of home nasogastric feeding is safe and recommended before gastrostomy placement, particularly for children likely to achieve oral feeding.
• Routine contrast studies are not indicated prior to gastrostomy placement.
• Laparoscopic gastrostomy insertion is associated with the best safety profile.

Conclusions:

• Recommendations for pediatric gastrostomy placement are primarily based on observational studies and expert opinion.
• Further patient- and family-centered research is needed for decision-making regarding surgically placed enteral access devices in children.