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Retrograde percutaneous gastrostomy: a prospective study in 57 children
S J King1, P G Chait, A Daneman
1Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Retrograde Percutaneous Gastrostomy (RPG) is a feasible and safe procedure for pediatric feeding tube placement. This study found high success rates and minimal complications in 57 children, enabling improved nutrition.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Procedures
- Interventional Radiology
Background:
- Percutaneous gastrostomy tube placement is crucial for nutritional support in children.
- Limited data exists on the safety and efficacy of the retrograde approach in a large pediatric cohort.
- Understanding complications and success rates of Retrograde Percutaneous Gastrostomy (RPG) is essential for clinical practice.
Purpose of the Study:
- To prospectively evaluate the feasibility and complication profile of Retrograde Percutaneous Gastrostomy (RPG) in pediatric patients.
- To assess the success rate of catheter placement using the retrograde technique in a large series of children.
- To document any adverse events or complications associated with RPG in this cohort.
Main Methods:
- Prospective study of 57 children (3 weeks to 17 years) undergoing Retrograde Percutaneous Gastrostomy (RPG).
- Procedures performed under IV sedation, oral sedation, general anesthesia, or local anesthesia.
- Detailed description of the retrograde technique for gastrostomy or gastrojejunostomy catheter placement.
Main Results:
- Successful catheter placement in 56 out of 57 children (98.2% success rate).
- One initial misplacement corrected during the procedure; one dislodgement requiring replacement.
- Minor complications included transient abdominal tenderness and fever in two children; no septicemia or significant infections reported.
Conclusions:
- Retrograde Percutaneous Gastrostomy (RPG) is a highly feasible and safe technique for pediatric gastrostomy and gastrojejunostomy.
- The procedure demonstrates a low complication rate, with significant benefits in weight gain and nutritional support for children.
- RPG offers a valuable option for enteral feeding in pediatric patients, supported by this large prospective study.
Abstract:
We prospectively studied Retrograde Percutaneous Gastrostomy (RPG) in 57 children (age 3 weeks-17 years, 1.7-48 kg) as the feasibility and complications of this technique have not been reported in a large series of children. We used IV sedation (42), oral sedation (4 neonates), general anaesthesia or local anaesthesia only. The retrograde approach for gastrostomy or gastrojejunostomy catheter placement is described. Catheter placement was unsuccessful in only one child, due to the presence of marked hepatosplenomegaly. Catheters were successfully placed in all the other 56 children. In one of these, catheter misplacement occurred due to retraction of the stomach from the anterior abdominal wall during its insertion. This was recognized during the procedure. The catheter was removed and reinserted on the same occasion. One catheter was accidentally pulled out after six days and was subsequently replaced. Two children had mild, local abdominal tenderness and fever for up to 48 hours but post procedure septicemia or significant infection were not encountered. All children benefitted from gastrostomy feeding and gained weight.