Abstract
Background
Enteral feeding is ideal for children with low caloric intake. It can be provided through different methods, including nasogastric, nasojejunal, gastrostomy, or gastrojejunostomy tubes.
Objective
To assess growth outcomes of pediatric patients following retrograde percutaneous gastrostomy (RPG) and compare complications with those following other gastrostomy methods.
Materials and methods
We retrospectively reviewed 120 random RPG patients from 2002 to 2003 (mean follow-up, 2.7 years). Patient weights and growth percentiles were recorded at insertion, and at 0–5 months, 6–12 months, and 18–24 months after insertion, and then compared using a Student’s t-test. Complications and tube maintenance issues (TMIs) were recorded.
Results
Gastrostomy tube insertion was successful in all 120 patients (59 boys, 61 girls; mean age 4.3 years). The most common underlying diagnosis was neurologic disease (29%, 35/120) and the main indication was inadequate caloric intake (24%, 29/120). Significant increases in growth percentile for the entire population were demonstrated between insertion and 0–5 months (18.7–25.3; P<0.001) and between insertion and 18–24 months (18.7–25.8; P<0.001). In boys and girls significant growth increases occurred between insertion and 0–5 months (boys P=0.004; girls P=0.01). There were 11 major postprocedural complications, 100 minor complications and 169 TMIs.
Conclusion
RPG provides long-term enteral nutrition in the pediatric population and increases growth significantly 6 and 24 months after insertion. Minor complications and TMIs are frequent.
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References
Leitch CA, Karn CA, Peppard RJ et al (1998) Increased energy expenditure in infants with cyanotic congenital heart disease. J Pediatr 133:755–760
Barton JS, Hindmarsh PC, Scrimgeour CM et al (1994) Energy expenditure in congenital heart disease. Arch Dis Child 70:5–9
Rosenfeld M, Casey S, Pepe M et al (1999) Nutritional effects of long-term gastrostomy feedings in children with cystic fibrosis. J Am Diet Assoc 99:191–194
Sullivan PB, Juszczak E, Bachlet AM et al (2005) Gastrostomy tube feeding in children with cerebral palsy: a prospective, longitudinal study. Dev Med Child Neurol 47:77–85
Norman K, Pichard C, Lochs H et al (2007) Prognostic impact of disease-related malnutrition. Clin Nutr 27:5–15
Blecker U, Mehta DI, Davis R et al (2000) Nutritional problems in patients who have chronic disease. Pediatr Rev 21:29–32
Hals J, Svalastog AG, Nilsen H (1996) Studies on nutrition in severely neurologically disabled children in an institution. Acta Paediatr 85:1469–1475
Wilson DC, Pencharz PB (1998) Nutrition and cystic fibrosis. Nutrition 14:792–795
Silk DBA (2003) Enteral vs parenteral nutrition. Clin Nutr 22:S43–S48
Ching YA, Gura K, Modi B et al (2007) Pediatric intestinal failure: nutrition, pharmacologic and surgical approaches. Nutr Clin Pract 22:653–663
Milla PJ (2007) Transition from parenteral to enteral nutrition. Nestle Nutr Workshop Ser Pediatr Program 59:105–111
Zambrano E, El-Hennawy M, Ehrenkranz RA et al (2004) Total parenteral nutrition induced liver pathology: an autopsy series of 24 newborn cases. Pediatr Dev Pathol 7:425–432
Quigley EM, Marsh MN, Shaffer JL (1993) Hepatobiliary complications of total parenteral nutrition. Gastroenterology 104:286–301
Preshaw RM (1981) A percutaneous method for inserting a feeding gastrostomy tube. Surg Gynecol Obstet 152:658–660
Friedman JN, Ahmed S, Connolly B et al (2004) Complications associated with image-guided gastrostomy and gastrojejunostomy tubes in children. Pediatrics 114:458–461
Chait PG, Weinberg J, Connolly B et al (1996) Retrograde percutaneous gastrostomy and gastrojejunostomy in 505 children: a 4 1/2-year experience. Radiology 201:691–695
Wollman B, D’Agostino HB, Walus-Wigle JR et al (1995) Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature. Radiology 197:699–704
Barron MA, Duncan DS, Green GJ et al (2000) Efficacy and safety of radiologically placed gastrostomy tubes in paediatric haematology/oncology patients. Med Pediatr Oncol 34:177–182
Zamakhshary M, Jamal M, Blair GK et al (2005) Laparoscopic vs percutaneous endoscopic gastrostomy tube insertion: a new pediatric gold standard? J Pediatr Surg 40:859–862
Aziz D, Chait P, Kreichman F et al (2004) Image-guided percutaneous gastrostomy in neonates with esophageal atresia. J Pediatr Surg 39:1648–1650
Connolly BL (2003) Gastrointestinal interventions – emphasis on children. Tech Vasc Interv Radiol 6:182–191
Ozmen MN, Akhan O (2002) Percutaneous radiologic gastrostomy. Eur J Radiol 43:186–195
Rothenberg SS, Bealer JF, Chang JH (1999) Primary laparoscopic placement of gastrostomy buttons for feeding tubes: a safer and simpler technique. Surg Endosc 13:995–997
Khattak IU, Kimber C, Kiely EM et al (1998) Percutaneous endoscopic gastrostomy in paediatric practice: complications and outcome. J Pediatr Surg 33:67–72
Barkmeier JM (1998) Percutaneous radiologic, surgical endoscopic, and percutaneous endoscopic gastrostomy/gastrojejunostomy: comparative study and cost analysis. Cardiovasc Intervent Radiol 21:324–328
King SJ, Chait P, Daneman A et al (1993) Retrograde percutaneous gastrostomy: a prospective study in 57 children. Pediatr Radiol 23:23–25
Efrati O, Mei-Zahav M, Rivlin J et al (2006) Long-term nutritional rehabilitation by gastrostomy in Israeli patients with cystic fibrosis: clinical outcome in advanced pulmonary disease. J Pediatr Gastroenterol Nutr 42:222–228
Rempel GR, Colwell SO, Nelson RP (1988) Growth in children with cerebral palsy fed via gastrostomy. Pediatrics 82:857–862
National Center for Chronic Disease Prevention and Health Promotion (2008) Overview of the CDC Growth Charts. Centers for Disease Control and Prevention, Atlanta. Accessed 16 June 2008
Dieticians of Canada; Canadian Paediatric Society; College of Family Physicians of Canada; Community Health Nurses Association of Canada (2004) The use of growth charts for assessing and monitoring growth in Canadian infants and children. Can J Diet Pract Res 65:22–32
Kuczmarski RJ, Ogden CL, Grummer-Strawn LM et al (2000) CDC growth charts: United States. Advance Data, no. 314, pp 1–27
Bradley LJ, Greenwood RJ, Silk DB (2003) Clinically significant benign pneumoperitoneum as a complication of percutaneous endoscopic gastrostomy. Clin Rehabil 17:228–229
Chen W, Kawahara H, Takahasi M et al (2006) Marked pneumoperitoneum 3 weeks after percutaneous endoscopic gastrostomy. J Gastroenterol Hepatol 21:919–921
Roberts PA, Wrenn K, Lundquist S (2005) Pneumoperitoneum after percutaneous endoscopic gastrostomy: a case report and review. J Emerg Med 28:45–48
Kealey WD, McCallion WA, Boston VE (1996) Tension pneumoperitoneum: a potentially life-threatening complication of percutaneous endoscopic gastrojejunostomy. J Pediatr Gastroenterol Nutr 22:334–335
Bernstein S, Weinstein M, Connolly B et al (2001) Subcutaneous emphysema in a pediatric patient after radiologic placement of a percutaneous gastrostomy tube. AJR 177:693–694
Sacks D, McClenny TE, Cardella JF et al (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202
Marx MV, Williams DM, Perkins AJ et al (1996) Percutaneous feeding tube placement in pediatric patients: immediate and 30-day results. J Vasc Interv Radiol 7:107–115
Claris-Appiani A, Ardissino GL, Dacco V et al (1995) Catch-up growth in children with chronic renal failure treated with long-term enteral nutrition. JPEN J Parenter Enteral Nutr 19:175–178
Boersma B, Wit JM (1997) Catch-up growth. Endocr Rev 18:646–661
Mathus-Vilegan LM, Koning H (1999) Percutaneous endoscopic gastrostomy and gastrojejunostomy: a critical reappraisal of patient selection, tube function and the feasibility of nutritional support during extended follow-up. Gastrointest Endosc 50:746–754
Liu RM, Papsin BC, de Jong AL (1999) Epidermolysis bullosa of the head and neck: a case report of laryngotracheal involvement and 10-year review of cases at the Hospital for Sick Children. J Otolaryngol 28:76–82
Marinkovich MP, Pham N (eds) (1996) Epidermolysis bullosa (monograph online). eMedicine. http://www.emedicine.com/DERM/topic124.htm. Accessed 16 June 2008
Pai S, Marinkovich MP (2002) Epidermolysis bullosa new and emerging trends. Am J Clin Dermatol 3:371–380
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Lewis, E.C., Connolly, B., Temple, M. et al. Growth outcomes and complications after radiologic gastrostomy in 120 children. Pediatr Radiol 38, 963–970 (2008). https://doi.org/10.1007/s00247-008-0925-7
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DOI: https://doi.org/10.1007/s00247-008-0925-7