Postoperative complications following percutaneous endoscopic gastrostomy are common in children

Hansen, Erik Søren Halvard; Qvist, Niels; Rasmussen, Lars Melholt; Ellebæk, Mark Bremholm

doi:10.1111/apa.13865

Cited by 16 publications

(19 citation statements)

References 20 publications

(33 reference statements)

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“…This is lower than other reports from Nordic countries, which have reported mortality rates between 18% and 25%. 9,11,26 However, the follow-up time differed both within and across these studies, from 1 to 20 years, making a comparison difficult.…”

Section: Discussionmentioning

confidence: 99%

Gastrostomy tube insertion in children with developmental or acquired disorders: a register‐based study

Backman

Sjögreen

2020

Develop Med Child Neuro

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Aim To describe trends in gastrostomy tube insertion in children with developmental or acquired disorders in Sweden and assess their demographic characteristics. Method Children aged 0 to 18 years with gastrostomy tube insertions recorded between 1998 and 2014 were identified in the Swedish National Patient Register. Associations between disorder type and year of surgery, as well as age at surgery, were analysed using linear regression analyses. The association between disorder type and mortality 2 years from gastrostomy tube insertion was also analysed using logistic regression analysis. Results The data for 4112 children (2182 males, 1930 females), with a median age of 2 years (interquartile range=1–8y), were analysed. Children who presented with developmental disorders were the largest group (n=3501, 85%). The most common diagnosis in children with developmental disorders was cerebral palsy (n=165, 4%). In children with acquired disorders, acute lymphoblastic leukaemia (n=117, 3%) was the most common diagnosis. Gastrostomy tube insertions increased from 1998 to 2014, with the greatest increase in children with developmental disorders, who were younger than children with acquired disorders when the gastrostomy tube was first inserted. Age at tube insertion decreased in both groups during the study period. Mortality was higher in children with acquired disorders, suggesting that gastrostomy tube insertion should be part of a palliative care approach. Interpretation Child characteristics differed depending on whether the underlying disorder was developmental or acquired, suggesting a need for clinical health care guidelines related to the specific goals of gastrostomy tube insertion. What this paper adds Gastrostomy tube insertions increased by 140% from 1998 to 2014 in Sweden. The age of children with developmental disorders decreased by 1 month per year during the study period. Children presenting with developmental disorders were younger than children with acquired disorders when the gastrostomy tube was first inserted. Mortality was higher in children with acquired disorders.

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Section: Discussionmentioning

confidence: 99%

Gastrostomy tube insertion in children with developmental or acquired disorders: a register‐based study

Backman

Sjögreen

2020

Develop Med Child Neuro

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“…Our series does not report greatly increased proportions of complications in ARPKD patients compared to other pediatric patients. The most frequent reported complications were excessive granulation tissue and wound infection not exceeding complication rates in larger series of children with percutaneous endoscopic or laparoscopic gastrostomy ( 12 , 14 – 16 ). Two cases reported in our study deserve a closer look: in one patient who had undergone bilateral nephrectomy and who suffered from severe blood pressure variations, arterial hypotension developed during anesthetic induction for gastrostomy insertion.…”

Section: Discussionmentioning

confidence: 92%

Gastrostomy Tube Insertion in Pediatric Patients With Autosomal Recessive Polycystic Kidney Disease (ARPKD): Current Practice

et al. 2018

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Introduction: Autosomal recessive polycystic kidney disease (ARPKD) is a severe hepatorenal disorder of childhood. Early renal disease in ARPKD may require renal replacement therapy and is associated with failure to thrive resulting in a need for nasogastric tube feeding or gastrostomy. In ARPKD patients, the benefit of a gastrostomy in nutrition and growth needs to be weighed against the potential risk of complications of congenital hepatic fibrosis (CHF) and portal hypertension like variceal bleeding. CHF in ARPKD has thus been considered as a relative contraindication for gastrostomy insertion. Yet, data on gastrostomies in pediatric patients with ARPKD is lacking.Methods: We conducted a web-based survey study among pediatric nephrologists, pediatric hepatologists and pediatric gastroenterologists on their opinions on and experiences with gastrostomy insertion in ARPKD patients.Results: 196 participants from 39 countries shared their opinion. 45% of participants support gastrostomy insertion in all ARPKD patients, but portal hypertension is considered to be a contraindication by a subgroup of participants. Patient-specific data was provided for 38 patients indicating complications of gastrostomy that were in principal comparable to non-ARPKD patients. Bleeding episodes were reported in 3/38 patients (7.9%). Two patients developed additional severe complications. Gastrostomy was retrospectively considered as the right decision for the patient in 35/38 (92.1%) of the cases.Conclusions: This report on the results of an online survey gives first insights into the clinical practice of gastrostomy insertion in ARPKD patients. For the majority of participating physicians benefits of gastrostomy insertion retrospectively outweigh complications and risks. More data will be required to lay the foundation for clinical recommendations.

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“…Other studies defined major complications by unplanned events—for example, a hospital admission or interventional procedure 17,42,44 . Different definitions have led to variations in major complications from 6.1%–17.5% in noncancer populations 46 …”

Section: Discussionmentioning

confidence: 99%

“…17,42,44 Different definitions have led to variations in major complications from 6.1%-17.5% in noncancer populations. 46 The most frequent complications were inflammation and infection of the gastrostomy site, comprising 40%-50% of total episodes. Significantly more infections were seen in 11 children undergoing BMT compared with those not undergoing BMT.…”

Section: Complicationsmentioning

confidence: 99%

Systematic review of gastrostomy complications and outcomes in pediatric cancer and bone marrow transplant

et al. 2021

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Background: Nutrition support is essential in children with cancer, including those undergoing bone marrow transplant (BMT), to reduce the risk of malnutrition and associated deleterious outcomes. Enteral nutrition is more commonly provided via nasogastric than gastrostomy tubes because of safety concerns with the latter in immunocompromised children. This systematic review investigated the incidence and type of complications and outcomes in pediatric cancer patients fed by gastrostomy. Methods: Databases were searched for randomized and observational studies investigating the use of any gastrostomy device in children aged <18 years with any cancer diagnosis, including those undergoing BMT. Five cohort and 11 case series studies were included. Owing to clinical heterogeneity, meta-analyses were not performed.Results: Quality of evidence varied, with five studies judged at serious risk of bias and poor quality; however, the remaining 11 were considered to range from moderate to good quality. Across studies, 54.6% of children developed one or more complications, of which 76.6% were classified as minor, 23.4% major. The most frequent complications included inflammation (52% of episodes), infection (42.1%), leakage (22.3%), and granuloma (21%). Evidence regarding infection rates in cancer/BMT patients compared with other disease states was inconclusive.Gastrostomy feeding was associated with improvement or stabilization of nutrition status in 77%-92.7% of children.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Postoperative complications following percutaneous endoscopic gastrostomy are common in children

Abstract: Gastrostomy feeding tube placement was associated with a high rate of postoperative complications of various grades when the pull-through method was the standard procedure. A consensus on how to report and grade complications arising from this procedure is warranted.

Cited by 16 publications

References 20 publications

Gastrostomy tube insertion in children with developmental or acquired disorders: a register‐based study

Gastrostomy tube insertion in children with developmental or acquired disorders: a register‐based study

Gastrostomy Tube Insertion in Pediatric Patients With Autosomal Recessive Polycystic Kidney Disease (ARPKD): Current Practice

Systematic review of gastrostomy complications and outcomes in pediatric cancer and bone marrow transplant

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