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

Leo, Grazia Di; Pascolo, Paola; Hamadeh, Kamar; Trombetta, Andrea; Ghirardo, Sergio; Schleef, Jürgen; Barbi, Egidio; Codrich, Daniela

doi:10.3390/nu11071555

Cited by 29 publications

(19 citation statements)

References 21 publications

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“…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.…”

Section: Discussionsupporting

confidence: 92%

“…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. In other studies, the most significant indications for PEG included dysphagia due to neurological disorders 10 , neuromuscular and metabolic causes, congenital heart diseases, oncological diseases, cystic fibrosis, and esophageal diseases 1,8,9,12 .…”

Section: Discussionmentioning

confidence: 99%

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

Özçelik

Cesur

Taşkın³

2023

Cukurova Medical Journal

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Purpose: Percutaneous endoscopic gastrostomy is the most preferred method for feeding in children with intact gastrointestinal system functions when oral nutrition is insufficient due to neurological, neuromuscular, or oncological diseases. This study aimed to evaluate the indications for percutaneous endoscopic gastrostomy and associated complications in the patients we followed up. Materials and Methods: In this descriptive study, the records of 130 patients who underwent percutaneous endoscopic gastrostomy for nutritional support between January 1st 2013- December 30th 2020 were retrospectively reviewed. Demographic data, indications, complications, and follow-up periods of the patients were examined. Results: Of the patients, 75 were male and 55 were female. The mean age of the patients was 48 months (min 1 month-max 211 months). The evaluation of the patients with percutaneous endoscopic gastrostomy in terms of diagnosis revealed that 95 patients required nutritional support due to neuromotor retardation associated with neurological disease, 19 patients due to central nervous system tumor, and 13 patients due to metabolic disease. Considering complications, the most frequent minor complication was leakage in 11of the 33 patients, while the most frequent major complication was colonic fistulation in 6 of the 9 patients. Two patients required open surgery in the early period due to intra abdominal leak. Conclusion: Although enteral nutrition with a percutaneous endoscopic gastrostomy tube seems to be an appropriate and reliable method to meet the nutritional needs of pediatric patients who have normal digestive system functions but cannot be fed orally due to swallowing disorders, it is necessary to pay attention to its complications like any surgical procedure.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

Özçelik

Cesur

Taşkın³

2023

Cukurova Medical Journal

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“…In a case series report, 84 children with neurocognitive impairment received gastrostomy due to severe dysphagia (53% of the study population), malnutrition (21.4%), risk of aspiration pneumonia (10.7%), and aversion to food (7.1%). 41 After gastrostomy placement, the number of children presenting malnutrition decreased from 33.3% to 4.4%, p < 0.0001. 41 The frequency of respiratory infection also decreased significantly, p ¼ 0.00037.…”

Section: Management General Managementmentioning

confidence: 91%

Clinical management and diagnosis of CLN2 disease: consensus of the Brazilian experts group

et al. 2023

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Neuronal ceroid lipofuscinosis type 2 (CLN2) is a rare neurodegenerative genetic disease that affects children in early life. Its classic form is rapidly progressive, leading to death within the first 10 years. The urge for earlier diagnosis increases with the availability of enzyme replacement therapy. A panel of nine Brazilian child neurologists combined their expertise in CLN2 with evidence from the medical literature to establish a consensus to manage this disease in Brazil. They voted 92 questions including diagnosis, clinical manifestations, and treatment of the disease, considering the access to healthcare in this country. Clinicians should suspect CLN2 disease in any child, from 2 to 4 years old, with language delay and epilepsy. Even though the classic form is the most prevalent, atypical cases with different phenotypes can be found. Electroencephalogram, magnetic resonance imaging, molecular and biochemical testing are the main tools to investigate and confirm the diagnosis. However, we have limited access to molecular testing in Brazil, and rely on the support from the pharmaceutical industry. The management of CLN2 should involve a multidisciplinary team and focus on the quality of life of patients and on family support. Enzyme replacement therapy with Cerliponase α is an innovative treatment approved in Brazil since 2018; it delays functional decline and provides quality of life. Given the difficulties for the diagnosis and treatment of rare diseases in our public health system, the early diagnosis of CLN2 needs improvement as enzyme replacement therapy is available and modifies the prognosis of patients.

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“…Based on International consensus on the diagnosis and management of dumping syndrome [ 34 ], the syndrome is subdivided into early (hyperglycaemia, gastrointestinal, and vasomotor symptoms occurring within the first hour after a meal) and late (reactive hypoglycaemia 1–3 h after a meal) forms. This pathology is a frequent complication of oesophageal and gastric surgery and was also reported in children after gastrostomy placement [ 35 ]. Dumping syndrome which occurs in non-surgical patients is classified as idiopathic.…”

Section: Discussionmentioning

confidence: 99%

Continuous Glucose Monitoring in Enterally Fed Children with Severe Central Nervous System Impairment

et al. 2023

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Children with severe central nervous system (CNS) impairment are at risk of developing various degrees of nutritional deficit that require long-term nutritional intervention. Interventions are most often implemented through enteral nutrition (EN) using commercially manufactured feeds administered via gastro/jejunostomy or nasogastric or nasojejunal tubes. The modality of feeding—continuous feeding or bolus feeding—is dependent on the function of the gastrointestinal tract, particularly the efficiency of gastric emptying. In the literature, the relationship between this type of nutrition and the occurrence of hyperglycaemia is often discussed. In addition, children with chronic neurological diseases are vulnerable to disorders of many mechanisms of neurohormonal counter-regulation related to carbohydrate management, and due to limited verbal and logical contact, it is difficult to recognise the symptoms of hypoglycaemia in such patients. We aimed to assess the carbohydrate metabolism in children with severe CNS impairment, with enteral nutrition delivered via nasogastric, nasoenteral, or percutaneous tubes, based on continuous glycaemic monitoring (CGM) and the measurement of glycated haemoglobin (HbA1c) levels. Materials and methods: This prospective, observational study included nineteen patients (median (25–75 pc) age: 12.75 (6.17–15.55) years) with permanent CNS damage (Gross Motor Function Classification System V) receiving long-term tube enteral feeding, recruited from two paediatric university nutritional treatment centres. Patients with acute conditions and diagnosed diabetes were excluded. The nutritional status and nutritional support were analysed in all the inpatients in accordance with a uniform protocol. Using the CGM system (Medtronic iPro2), glycaemic curves were analysed, and in addition, HbA1C levels were determined in fourteen patients. CGM results were analysed using GlyCulator2.0. Statistical analysis was performed using the Statistica version 11 software (StatSoft Inc. Tulsa, OK, US). Results: More than half (11/19; 58%) of the patients were undernourished (BMI < 3 pc for age and gender), with the stature age being significantly lower than calendar age (5 (4.5–9) vs. 12.75 (6.17–15.55) years; p = 0.0010). The actual caloric intake was 50 (37.7–68.8) kcal/kg (median; 25–75 pc). In patients fed using the bolus method, the number of calories consumed per day was statistically significantly higher than in children subjected to a continuous feeding supply (56.00 (41.00–75.00) vs. 33.40 (26.70–50.00) kcal/kg BW (body weight; p = 0.0159). Decreases in blood glucose levels below the alarm level (<70 mg/dl) were recorded in fifteen patients (78.9%), including two patients with episodes of clinically significant hypoglycaemia (<54 mg/dl). The minimum and maximum glycaemic values recorded in any individual CGM records were 67 mg/dl (median) (minimum: 41 mg/dl; maximum: 77 mg/dl) and 146 (minimum: 114 mg/dl; maximum: 180 g/dl), respectively, for the entire recording. The maximum percentage of glycaemic concentrations > 140 mg/dl (TAR 140) recorded overnight in children with BMI ≥ 3 amounted to 1,6% vs. 0% in undernourished patients (TAR 140: 0.0 (0.00–1.6%) vs. 0% (0.00–0.0%; p = 0.0375); the percentage of glycaemic concentrations <70 mg/dl in the entire recording was comparable (0.77% (0.13–2.2%) vs. 1.8% (0.5–14.4%) vs. p = 0.2629). There was a positive correlation between the mean daily glucose recorded using the CGM method and patients’ BMI z-scores (R = 0.48, p = 0.0397). No statistically significant relationship was demonstrated between the occurrence of alarm hypoglycaemia events in the CGM records and undernutrition expressed by BMI z-scores (OR = 1.50 (95%CI: 0.16–13.75), the type of diet (for commercially manufactured OR = 0.36 (95%CI: 0.04–3.52), and the modality of diet delivery (for bolus feeding OR = 2.75 (95%CI: 0.28–26.61). Conclusions: In children with chronic OU damage, enteral feeding is associated with a risk of hypoglycaemia, but further studies involving a larger number of patients are needed, and CGM might be a useful tool to estimate the metabolic adequacy of enteral nutritional support in terms of glucose control.

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

Cited by 29 publications

References 21 publications

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

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

Clinical management and diagnosis of CLN2 disease: consensus of the Brazilian experts group

Continuous Glucose Monitoring in Enterally Fed Children with Severe Central Nervous System Impairment

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