Rate of paediatric gastrostomy insertion in England and relationship to epidemiology of cerebral palsy

Abstract

Background and objectivesGastrostomy tubes are commonly used to provide an alternative route for enteral nutrition. Most of the gastrostomies are inserted in children with cerebral palsy. Previous studies have shown an increase in insertion rate, however, epidemiological studies reveal a stasis in prevalence of cerebral palsy. We aimed to provide an up-to-date rate of gastrostomy insertion in children in England over a 20-year period and systematically review the prevalence of cerebral palsy to ascertain an epidemiological explanation for insertion trends.MethodsRetrospective search of Hospital Episode Statistic, a database held diagnosis and procedural code from all England National Health Service hospitals from 2000 to 2021 using International Classification of Disease-10 and Office of Population Censuses and Survey’s Classification-4. England Office for National Statistics data were used for population census. MEDLINE and EMBASE were systematically searched for epidemiology of cerebral palsy.ResultsThere were 23 079 gastrostomies inserted in children <15 years in England (2000–2021) leading to a frequency of 12.4 insertions per 100 000 children per year and 1383 gastrostomy insertions in 15–18 years age group (6 per 100 000). The overall gastrostomy insertion rate in children <15 years has increased from 3.7 procedures per 100 000 in 2000 to 18.3 per 100 000 in 2017. Prevalence of cerebral palsy remained stable (1.5–3.3 per 1000 birth) since 1985.ConclusionsThere was a significant increase in the rate of gastrostomy insertion in children in England during most of the last 20 years not explained by a stable prevalence of cerebral palsy.

Do sociodemographic and clinical characteristics affect mortality rates in people with intellectual disability and dysphagia who have a percutaneous endoscopic gastrostomy? A cohort study between 2000 and 2022

“…In a study based in Australia, PEGs were increasingly inserted in intellectually disabled children in their pre-school years (Glasson et al, 2018). In England, there has been an increase in PEG insertion rates in children and in particular children with cerebral palsy (Popescu & Mutalib, 2023). The authors speculated that this increase in PEG insertion was not due to an increase in the prevalence of disorders or conditions that may require PEG feeding.…”

Prophylactic anti‐reflux procedure for children undergoing laparoscopic gastrostomy: Rethinking of the routine practice

“…Gastrostomy tube insertion is a widely performed procedure in pediatric surgery, with rates of insertion increasing worldwide. [1][2][3][4] Gastrostomy tubes are commonly used in patients who require additional nutritional support via enteral feeding due to feeding difficulties. [3][4][5][6] Conditions that frequently indicate gastrostomy insertion include neurological impairment (NI), [2][3][4][5][6][7] cerebral palsy [3][4][5][6] and congenital malformation.…”

“…[1][2][3][4] Gastrostomy tubes are commonly used in patients who require additional nutritional support via enteral feeding due to feeding difficulties. [3][4][5][6] Conditions that frequently indicate gastrostomy insertion include neurological impairment (NI), [2][3][4][5][6][7] cerebral palsy [3][4][5][6] and congenital malformation. 4,6 These patients often have complex medical requirements.…”

“…2,4 Impaired swallowing can lead to malnutrition and food aspiration, causing recurrent aspiration pneumonia; thus, an alternative long-term feeding arrangement is needed. [3][4][5] Gastrostomy has been shown to improve nutritional status and reduce lung complications, [3][4][5] with high rates of patient and family satisfaction. 5 Previous studies have reported that gastrostomy insertion is associated with gastroesophageal reflux (GOR).…”

The impact of low‐energy, partially hydrolysed enteral formula on gastrointestinal symptoms and weight in children with neurological impairment: a multicentre retrospective study

“…10 Gastrostomy insertion rates have been increasing in England over the past 19 years, from 3.7 to 18.3 procedures per 100,000 children under the age of 15 years, with no parallel increase in CP prevalence. 11 Children with severe CP are prone to a positive energy balance associated with reduced energy expenditure and both high body fat mass and low muscle mass. Although tube feeding improves overall nutritional status, it has also been associated with excess deposition of body fat compared with typically developing children.…”