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Retrograde percutaneous gastrostomy and gastrojejunostomy in 505 children: a 4 1/2-year experience
P G Chait1, J Weinberg, B L Connolly
1Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Retrograde insertion of gastrostomy and gastrojejunostomy tubes is a safe and effective method for providing long-term nutrition in children. This technique, guided by radiology, offers a viable solution for pediatric patients requiring nutritional support.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
- Surgical Techniques
Background:
- Gastrostomy and gastrojejunostomy tubes are crucial for long-term nutritional support in pediatric patients.
- Traditional insertion methods may have limitations in certain pediatric populations.
- Radiologic guidance offers enhanced precision and safety during tube placement.
Purpose of the Study:
- To evaluate the safety and efficacy of retrograde insertion of gastrostomy and gastrojejunostomy tubes in children.
- To assess the success rates and complication profiles of this technique.
- To determine the suitability of retrograde placement for pediatric patients requiring enteral feeding.
Main Methods:
- A retrospective review of 453 pediatric patients (ages premature to 18.6 years) who underwent attempted retrograde gastrostomy or gastrojejunostomy tube insertion over 4.5 years.
- Analysis of initial placement success, conversion rates, and early (<30 days) and late complications.
- Identification of factors contributing to unsuccessful placement and complications requiring surgical intervention.
Main Results:
- Successful placement was achieved in the majority of patients, with initial gastrostomy tube placement in 436 and gastrojejunostomy tube in 69.
- Early complications included skin infection (11) and stoma irritation (20); late complications included stoma irritation (29) and skin infection (23).
- Two complications necessitated surgery, with no tube-related deaths reported.
Conclusions:
- Percutaneous retrograde placement of gastrostomy or gastrojejunostomy tubes is a safe and effective method for providing long-term nutrition in children.
- A multidisciplinary team approach is vital for optimal patient care and service delivery.
- This technique provides a reliable option for pediatric enteral feeding, minimizing the need for more invasive procedures.
Purpose:
To evaluate a technique of retrograde insertion of gastrostomy and gastrojejunostomy tubes with radiologic guidance in children.
Materials And Methods:
During a 4 1/2-year period, 511 patients underwent attempted insertion of gastrostomy or gastrojejunostomy tubes. Patients' ages ranged from premature to 18.6 years (mean age, 3.8 years), and weight range was 0.8-86.0 kg (mean weight, 12 kg). The charts of 453 patients were reviewed.
Results:
Placement was unsuccessful in six patients because of colonic interposition (n = 2), microgastria (n = 2), or hepatosplenomegaly (n = 2). Initial placement was a gastrostomy tube in 436 patients and a gastrojejunostomy tube in 69 patients. Sixty-eight gastrostomy tubes were converted to gastrojejunostomy tubes. Early complications (< 30 days) included skin infection (n = 11), stoma irritation (n = 20), and tube dislodgment (n = 6). Late complications included stoma irritation (n = 29), skin infection (n = 23), tube leakage (n = 14), and discomfort during feeding (n = 15). Two complications necessitated surgery: extragastric misplacement and small-bowel transgression. There were no tube-related deaths.
Conclusion:
Percutaneous retrograde placement of gastrostomy or gastrojejunostomy tubes safely and effectively provides long-term nutrition for children. A team approach is essential to provide service to this cumulative population.