Complications in patients with neurological impairment after gastrostomy

Abstract

Background Neurological impairment (NI) is responsible for most conditions that require a permanent gastrostomy tube. The present study assessed the occurrence of short‐ and long‐term complications after video‐assisted gastrostomy (VAG) in patients with NI. Methods The incidence of short‐ (<6 months) and long‐term (over 2 years) complications of VAG were analyzed in a retrospective study. The differences between the incidence of the complications of VAG according to the age at surgery (≤15 years vs. ≥16 years) were also evaluated. The short‐ and long‐term complications observed were granulation tissue formation, infection requiring antibiotic treatment, skin problems, perigastrostomy leakage, vomiting, accidental tube dislodgement, dumping syndrome, ileus, and peritonitis. Results Eighty‐two patients were evaluated for short‐ and long‐term complications. The long‐term complication rate was significantly lower than the short‐term complication rate (P = 0.0026). Onodera’s prognostic nutritional index before VAG in patients with long‐term complications was significantly lower than in patients without such complications (P = 0.046). The incidence of long‐term granulation tissue formation, infection, and vomiting were significantly lower than those of similar short‐term complications. Long‐term skin problems were associated with short‐term skin problems (odds ratio: 18.95; 95% confidence interval: 4.53–92.98; P < 0.001). The number of patients ≥16 years old with short‐ and long‐term skin problems was significantly higher than in patients ≤15 years old (P = 0.0014 and P = 0.0073, respectively). Conclusions The incidence rate of granulation tissue formation and infection after VAG were lower in the long term than in the short term. However, patients ≥16 years old presented with persistent complications.

The Evaluation of Gastric Emptying Using the ¹³C-Acetate Breath Test in Neurologically Impaired Patients – A Focus on the Stomach Function and Morphology –

“…At present, percutaneous endoscopic gastrostomy (PEG) is the standard gastrostomy technique. However, NI patients usually undergo a permanent gastrostomy or fundoplication using the laparoscopic assisted gastrostomy (LAG) procedure because of anatomical difficulties of NI patients [1][2][3][4]. Additionally, several studies have shown that delayed gastric emptying (DGE), which is a medical disorder involving weak muscular contractions of the stomach, is common in NI patients with an incidence rate of > 50.0% [5][6][7][8].…”