Gastrostomy Placement and Management in Children: A Single-Center Experience

Abstract

BACKGROUND: To prevent malnutrition and food aspiration in children with chronic neuromuscular problems, enteral nutrition provided by gastrostomy is recommended. Long-term follow-up data about surgical and medical complications of PEG are available, but few papers have addressed all of the issues in the same series. METHODS: This retrospective study enrolled patients under 18 years who had a gastrostomy tube placed at our institution between 2003 and 2017. The aim is to evaluate outcomes after gastrostomy placement, focusing both on surgical complications (early and late), and its effect on their nutritional status, on the prevention of pulmonary infections, and their parents’ opinion. RESULTS: Eighty-four gastrostomies were placed in total (35 F; 49 M). Seventy-seven patients had a severe neurocognitive impairment (GMFCS 5). The principal indication for gastrostomy was severe dysphagia (53.3%). No gastrostomy-related death was observed. Early surgical complications were observed in five of 84 (5,9%) patients; late complications were observed in 15 of 84 (17.8%) patients. Twenty-two patients were diagnosed with subsequent gastroesophageal reflux; five patients developed dumping syndrome (6%). Complete medical follow-up data were available for 45 patients. A progressive improvement of nutritional status was observed in 29 patients, and 11 maintained the same percentile; the occurrence of respiratory infections and need for hospitalization decreased. In 90% of cases, parents were fully satisfied with the g-tube. CONCLUSION: This study confirms the positive nutritional outcomes of gastrostomy-tube with an associated small risk of surgical complications and a reduction in the number of respiratory infections, with most parents scoring their experience as positive.

Feeding with Care: Caregiver Perspectives on Pediatric Gastrostomy Tubes

“…Because of these benefits, more than half of the caregivers in our study reported that they would have accepted GT placement earlier if they were made aware of its advantages. This finding is consistent with other studies that have emphasized the critical role of early and clear communication between healthcare providers and families to facilitate timely decision-making [ 13 , 16 ]. It also highlights the need for educational programs for both the caregivers and the healthcare providers to raise awareness about the long-term benefits of GT placement and the benefits gained from its presence.…”

Feeding with Care: Caregiver Perspectives on Pediatric Gastrostomy Tubes

“…Because of these benefits, more than half of the caregivers in our study reported that they would have accepted GT placement earlier if they were made aware of its advantages. This finding is consistent with other studies that have emphasized the critical role of early and clear communication between healthcare providers and families to facilitate timely decision-making [ 13 , 16 ]. It also highlights the need for educational programs for both the caregivers and the healthcare providers to raise awareness about the long-term benefits of GT placement and the benefits gained from its presence.…”

Complications of percutaneous endoscopic gastrostomy in children: a single-center experience

“…When the distribution of the 130 patients in this study was analyzed, patients with neurological problems were found to comprise the largest group. This is consistent with large series published in the world 7,9,10 . Srinivasan et al 11 reported the most common indications for PEG as neurological diseases, followed by congenital heart diseases and chronic lung diseases, cleft palate, cleft lip, genetic diseases, malignancies, and metabolic diseases, respectively.…”

Point Prevalence of Gastrostomy in a Paediatric Population

“…Neurological disorders being the commonest underlying disorder leading to gastrostomy insertion in our population is in keeping with several published studies (1,2,16). This would explain the rates of insertion being highest in infancy and early childhood, as these conditions are often congenital or acquired in the perinatal or neonatal period.…”

Feeding with Care: Caregiver Perspectives on Pediatric Gastrostomy Tubes

“…Because of these benefits, more than half of the caregivers in our study reported that they would have accepted GT placement earlier if they were made aware of its advantages. This finding is consistent with other studies that have emphasized the critical role of early and clear communication between healthcare providers and families to facilitate timely decision-making [ 13 , 16 ]. It also highlights the need for educational programs for both the caregivers and the healthcare providers to raise awareness about the long-term benefits of GT placement and the benefits gained from its presence.…”

Complications of percutaneous endoscopic gastrostomy in children: a single-center experience

“…When the distribution of the 130 patients in this study was analyzed, patients with neurological problems were found to comprise the largest group. This is consistent with large series published in the world 7,9,10 . Srinivasan et al 11 reported the most common indications for PEG as neurological diseases, followed by congenital heart diseases and chronic lung diseases, cleft palate, cleft lip, genetic diseases, malignancies, and metabolic diseases, respectively.…”

Point Prevalence of Gastrostomy in a Paediatric Population

“…Neurological disorders being the commonest underlying disorder leading to gastrostomy insertion in our population is in keeping with several published studies (1,2,16). This would explain the rates of insertion being highest in infancy and early childhood, as these conditions are often congenital or acquired in the perinatal or neonatal period.…”

Feeding with Care: Caregiver Perspectives on Pediatric Gastrostomy Tubes

“…Because of these benefits, more than half of the caregivers in our study reported that they would have accepted GT placement earlier if they were made aware of its advantages. This finding is consistent with other studies that have emphasized the critical role of early and clear communication between healthcare providers and families to facilitate timely decision-making [ 13 , 16 ]. It also highlights the need for educational programs for both the caregivers and the healthcare providers to raise awareness about the long-term benefits of GT placement and the benefits gained from its presence.…”

Complications of percutaneous endoscopic gastrostomy in children: a single-center experience

“…When the distribution of the 130 patients in this study was analyzed, patients with neurological problems were found to comprise the largest group. This is consistent with large series published in the world 7,9,10 . Srinivasan et al 11 reported the most common indications for PEG as neurological diseases, followed by congenital heart diseases and chronic lung diseases, cleft palate, cleft lip, genetic diseases, malignancies, and metabolic diseases, respectively.…”

Point Prevalence of Gastrostomy in a Paediatric Population

“…Neurological disorders being the commonest underlying disorder leading to gastrostomy insertion in our population is in keeping with several published studies (1,2,16). This would explain the rates of insertion being highest in infancy and early childhood, as these conditions are often congenital or acquired in the perinatal or neonatal period.…”