Long‐term Outcomes of Infants and Children Undergoing Percutaneous Endoscopy Gastrostomy Tube Placement

McSweeney, Maireade E.; Jiang, Hongyu; Deutsch, Amanda J.; Atmadja, Melissa L.; Lightdale, Jenifer R.

doi:10.1097/mpg.0b013e3182a02624

Cited by 61 publications

(46 citation statements)

References 31 publications

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“…Prior data from our institution suggested that almost one-third of all patients undergoing primary percutaneous endoscopic gastrostomy (PEG) tube placement had a preoperative diagnosis of aspiration. 9, 16 After 2010, many aspirating children continued to be fed orally with thickened liquids rather than by g-tube.…”

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confidence: 99%

Oral Feeding Reduces Hospitalizations Compared with Gastrostomy Feeding in Infants and Children Who Aspirate

McSweeney

Kerr

Amirault

et al. 2016

The Journal of Pediatrics

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Objective To compare the frequency of hospitalization rates between aspirating patients treated with gastrostomy versus those fed oral thickened liquids. Study design A retrospective review was performed of patients with an abnormal videofluoroscopic swallow study between February 2006 and August 2013. 114 patients at Boston Children's Hospital were included. Frequency, length, and type of hospitalizations within one year of abnormal swallow study or gastrostomy tube placement were analyzed using a negative binomial regression model. Results Gastrostomy tube fed patients had a median of 2 (IQR: 1, 3) admissions per year as compared with orally fed patients who had a 1 (IQR: 0, 1) admissions per year, p<0.0001. Patients fed by gastrostomy were hospitalized for more days (median 24 (IQR: 6, 53) days) versus orally fed patients (median: 2 (IQR: 1, 4) days, (P<0.001)). Despite the potential risk of feeding patients orally, no differences in total pulmonary admissions (IRR: 1.65 (95%CI [0.70, 3.84])) between the two groups were found, except gastrostomy tube patients had 2.58 times (95%CI [1.02, 6.49]) more urgent pulmonary admissions. Conclusion Patients who underwent gastrostomy tube placement for the treatment of aspiration had two times as many admissions as compared with aspirating patients fed orally. We recommend a trial of oral feeding in all children cleared to take nectar or honey thickened liquids prior to gastrostomy tube placement.

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confidence: 99%

Oral Feeding Reduces Hospitalizations Compared with Gastrostomy Feeding in Infants and Children Who Aspirate

McSweeney

Kerr

Amirault

et al. 2016

The Journal of Pediatrics

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“…The fistula between the skin and the stomach was perforated with the blunt tip of MIC-KEY. This is a very rare complication when replacement is done later than 2 months after initial PEG placement 16. Intraperitoneal placement after 90 days has been described by Aprahamian et al after U-stitch laparoscopic gastrostomy (1.1%) 17.…”

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confidence: 98%

Fatal Complications after Pediatric Surgical Interventions: Lessons Learned

Klein

Putten

Küsters

et al. 2017

European J Pediatr Surg Rep

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Placement of catheters, drains, shunts, and tubes in children can lead to serious or even fatal complications at the moment of placement, such as hemorrhage at insertion, or in the longterm, such as infections and migration into adjacent organs. The clinician should always be aware of these potential complications, especially if the child is unwell. For postmortem diagnostic evaluation, either with a computed tomography scan or an invasive autopsy, all tubes, drains, shunts, and/or catheters should be left in situ. We present three cases with fatal complications after the placement of a chest drain, ventriculoperitoneal shunt, and gastrostomy tube.

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“…18 Prior literature has estimated about 4–6% of patients undergoing primary G-tube placement may go on to require conversion to transpyloric feeding, and in our cohort, approximately 8.8% required conversion. 3,7 Limited literature exists as to what diagnostic evaluation prior to tube placement may help predict which patients will go on to require transpyloric feeding; most of the pediatric literature to date has focused on differences in the pre-operative evaluation of patients who underwent a G-tube versus those who may also have required a G-tube and fundoplication procedure. 3,19 …”

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Preoperative Evaluation Is Not Predictive of Transpyloric Feeding Conversion in Gastrostomy‐dependent Pediatric Patients

McSweeney

Kerr

Amirault

et al. 2018

J. pediatr. gastroenterol. nutr.

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Objectives Limited literature exists as to whether preoperative GT evaluation may predict which patients will go onto require GJ feeding. The goal of this study was to compare the preoperative evaluations between patients maintained on GT feeds versus patients who required conversion to GJ feeds. Methods We identified patients at Boston Children’s Hospital who underwent GT placement and required GJ feeding between 2006–2012. GT patients were matched according to age, neurologic, and cardiac status with GJ converted patients. Preoperative characteristics, rates of total hospitalizations, and respiratory related admissions were reviewed. Results 79 GJ patients (median (IQR): age 15 (4.3, 55.7) months; weight 8.8 (4.6, 14.5) kg) were matched with 79 GT patients (median (IQR): age 14.6 (4.7, 55.7) months; weight 8.5 (5, 13.6) kg). Median time from GT to GJ conversion was 8 (IQR 3, 16) months. Both groups had similar rates of successful preoperative nasogastric feeding trials (GT (84.5%) vs GJ (83.1%), p=1.0), upper GI series (GT (89.1%) vs GJ (93.2%), p=0.73), abnormal videofluoroscopic swallow studies (GT (53.8%) vs GJ (62.2%), p=0.4), and completion of gastric emptying studies (GT (10.1%) vs GJ (5.1%), p=0.22). No differences were seen in preoperative hospitalization rates (p=0.25), respiratory admissions (p=0.36), although GJ patients had a mean reduction in the number of hospitalization of −1.5 ± 0.5 days, p<0.001, after conversion. Conclusions No differences in preoperative patient characteristics or diagnostic evaluations were seen in GT fed versus GJ converted patients. GJ patients did experience an overall decrease in total admissions after GJ conversion.

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Long‐term Outcomes of Infants and Children Undergoing Percutaneous Endoscopy Gastrostomy Tube Placement

Abstract: Children undergoing PEG placement have a long-term high risk of morbidity related to enteral tubes. Major complications can occur many years after PEG placement. Larger prospective studies may be useful to assess risk factors for PEG-related complications in pediatrics.

Cited by 61 publications

References 31 publications

Oral Feeding Reduces Hospitalizations Compared with Gastrostomy Feeding in Infants and Children Who Aspirate

Oral Feeding Reduces Hospitalizations Compared with Gastrostomy Feeding in Infants and Children Who Aspirate

Fatal Complications after Pediatric Surgical Interventions: Lessons Learned

Preoperative Evaluation Is Not Predictive of Transpyloric Feeding Conversion in Gastrostomy‐dependent Pediatric Patients

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