Evolution of gastrostomy tube management in a pediatric intestinal rehabilitation program

Many children with intestinal failure (IF) have gastrostomy tubes (G-tubes) for enteral nutrition. G-tubes are often placed at index admission and not removed until after parenteral nutrition (PN) is weaned off. This study aims to describe the evolution of G-tube management within an intestinal rehabilitation program that changed focus to prioritize oral feeding.

This is a retrospective review of electronic medical records of pediatric patients in a regional multidisciplinary intestinal rehabilitation program between 2008 and 2024. Two distinct management eras coincided with increased emphasis on oral nutrition. Early G-tube closure (prior to PN cessation) and traditional G-tube closure (after PN cessation) cohorts were compared using t-tests.

Seventy-eight percent (n = 114) of children underwent G-tube placement at median age of 3 months; 75 % were performed during index admission. From 2008-2015, there were 16 G-tube closures (8 early, 8 traditional), representing 28 % of all G-tubes in this early era. From 2016-2024, there were 40 G-tube closures (23 early, 17 traditional), representing 70 % of all G-tubes in this later era. Most closures were performed surgically. Among children with early G-tube closure, 25 % attained enteral autonomy while oral intake and growth progressed.

In an intestinal rehabilitation program with a renewed focus on oral feeding, more children underwent G-tube closure while dependent on PN and were still able to reach enteral autonomy. G-tube placement may not be necessary for all children with IF, and placement decisions should be made within a multidisciplinary intestinal rehabilitation program.