Day-case gastrostomy insertion in children: an achievable reality

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Clinical Outcomes

Background:

• Gastrostomy insertion is a common procedure for nutritional support.
• Reducing length of stay (LOS) is a key goal in optimizing patient care and healthcare resource utilization.
• Day-case gastrostomy (DCG) represents a potential strategy to streamline the gastrostomy insertion process.

Purpose of the Study:

• To evaluate the initial experience and feasibility of day-case gastrostomy (DCG) insertion.
• To assess the safety and outcomes of DCG in a pediatric population.
• To identify factors influencing the successful implementation of DCG.

Main Methods:

• Retrospective review of all primary gastrostomy insertions between April 2018 and April 2024.
• Definition of DCG as patients discharged on the same day of the procedure.
• Collection of demographic, operative, and clinical data, with all cases managed via a standardized feeding pathway.

Main Results:

• Fifteen out of 432 gastrostomies were performed as DCG, with a median age of 3.5 years and a LOS of 12 hours.
• Nutritional supplementation was the most common indication (n=9). Techniques included single-stage percutaneous rapid insertion of gastrostomy button (SPRING) and percutaneous endoscopic gastrostomy (PEG).
• Four minor complications occurred, with two requiring readmission. A significant proportion (8/15) had no prior nasogastric tube feeding experience.

Conclusions:

• Day-case gastrostomy (DCG) is a feasible and safe option for carefully selected patients.
• While most DCGs were performed on morning operating lists, prior nasogastric tube feeding experience was not universal.
• Further modifications to care pathways are recommended to increase the uptake and success of DCG procedures.