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Stavrou G, Gionga P, Chatziantoniou G, Tzikos G, Menni A, Panidis S, Shrewsbury A, Kotzampassi K. How far is the endoscopist to blame for a percutaneous endoscopic gastrostomy complication? World J Gastrointest Surg 2023; 15:940-952. [PMID: 37342839 PMCID: PMC10277955 DOI: 10.4240/wjgs.v15.i5.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/28/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is a well-established, minimally invasive, and easy to perform procedure for nutrition delivery, applied to individuals unable to swallow for various reasons. PEG has a high technical success rate of insertion between 95% and 100% in experienced hands, but varying complication rates ranging from 0.4% to 22.5% of cases.
AIM To discuss the existing evidence of major procedural complications in PEG, mainly focusing on those that could probably have been avoided, had the endoscopist been more experienced, or less self-confident in relation to the basic safety rules for PEG performance.
METHODS After a thorough research of the international literature of a period of more than 30 years of published “case reports” concerning such complications, we critically analyzed only those complications which were considered - after assessment by two experts in PEG performance working separately - to be directly related to a form of malpractice by the endoscopist.
RESULTS Malpractice by the endoscopist were considered cases of: Gastrostomy tubes passed through the colon or though the left lateral liver lobe, bleeding after puncture injury of large vessels of the stomach or the peritoneum, peritonitis after viscera damage, and injuries of the esophagus, spleen, and pancreas.
CONCLUSION For a safe PEG insertion, the overfilling of the stomach and small bowel with air should be avoided, the clinician should check thoroughly for the proper trans-illumination of the light source of the endoscope through the abdominal wall and ensure endoscopically visible imprint of finger palpation on the skin at the center of the site of maximum illumination, and finally, the physician should be more alert with obese patients and those with previous abdominal surgery.
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Affiliation(s)
- George Stavrou
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
- Department of Surgery, Addenbrooke's Hospital, Cambridge CB22QQ, United Kingdom
| | - Persefoni Gionga
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - George Chatziantoniou
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Georgios Tzikos
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Alexandra Menni
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Stavros Panidis
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Anne Shrewsbury
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Katerina Kotzampassi
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
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Persistent Diarrhoea after Percutaneous Endoscopic Gastrostomy (PEG) in Paediatric Patient: Lessons from a Complication. Case Rep Pediatr 2022; 2022:7663038. [PMID: 35719248 PMCID: PMC9205711 DOI: 10.1155/2022/7663038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) is increasingly used in paediatric population. We report a case of a 4-year-old boy who, two weeks after PEG placement, presented persistent diarrhoea interpreted as intolerance to enteral feeding. His CT scan confirmed the correct placement of gastrostomy, but during gastroscopy, gastrostomy could not be found in the stomach, and the following colonoscopy revealed migration of gastrostomy to the transverse colon. The patient required removal of the misplaced PEG and conservative management of the fistula with surgical replacement of gastrostomy. We faced an unusual presentation of PEG placement complication due to colon interposition during blind gastric puncture. In children with anatomical deformities, previous surgery, or low weight or malnutrition (<10 kg), we suggest laparoscopic-assisted gastrostomy to avoid the risk of a major complication.
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Hamada K, Tateishi J, Sugiki S, Ishisaka T, Igarashi Y, Kodera K, Okuno T, Morita T, Himeno T, Yano H, Higashikawa T, Iritani O, Iwai K, Morimoto S, Okuro M. Transient obstruction of the transverse colon caused by percutaneous endoscopic gastrostomy: A case report. Geriatr Gerontol Int 2021; 21:865-866. [PMID: 34250707 DOI: 10.1111/ggi.14226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/07/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Kazu Hamada
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Junnosuke Tateishi
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Shigeru Sugiki
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Taishi Ishisaka
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Yuta Igarashi
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Kumie Kodera
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Tazuo Okuno
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Takuro Morita
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Tarou Himeno
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Hiroshi Yano
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Toshihiro Higashikawa
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Osamu Iritani
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Kunimitsu Iwai
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Shigeto Morimoto
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
| | - Masashi Okuro
- Department of Geriatric Medicine, School of Kanazawa Medical University, Uchinada, Japan
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Gourishankar A. Indolent complication after percutaneous endoscopic gastrostomy: a case report of gastric fistula. WORLD JOURNAL OF PEDIATRIC SURGERY 2020; 3:e000202. [DOI: 10.1136/wjps-2020-000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/03/2022] Open
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Chuah YY, Lee YY, Tsai TJ. An unexpected cause of transient diarrhea. Postgrad Med 2017; 129:488-490. [PMID: 28335674 DOI: 10.1080/00325481.2017.1311198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Migration of percutaneous endoscopic gastrostomy (PEG) tube to colon with gastro-colonic-cutaneous fistula formation is a rare complication of the procedure. Transient episodic diarrhea following each PEG tube feeding is typical of this complication. We present a 72-year-old man with cerebrovascular disease and scoliosis who encountered episodes of transient diarrhea after each PEG tube feeding. His diarrhea was refractory to medications. Colonoscopy demonstrated a mal-positioned PEG in the transverse colon. Computed tomogram (CT) of abdomen further confirmed the finding. After removal of the migrated PEG, his diarrhea had ceased completely. The gastro-colonic-cutaneous fistula was further managed with endoscopic clipping method with no complications encountered during follow up.
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Affiliation(s)
- Yoen Young Chuah
- a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.,b Division of Gastroenterology and Hepatology, Department of Internal Medicine , Ping Tung Christian Hospital , Ping Tung , Taiwan
| | - Yeong Yeh Lee
- c Department of Medicine, School of Medical Sciences , Universiti Sains Malaysia , Kubang Kerian , Kelantan , Malaysia
| | - Tzung Jiun Tsai
- a Division of Gastroenterology and Hepatology, Department of Internal Medicine , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan
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Fernández-SanMillán D, López-Tomassetti Fernández E, Hernández Hernández JR. Gastric necrosis secondary to prolapse of a percutaneous gastrostomy. Cir Esp 2017; 95:474-475. [PMID: 28065535 DOI: 10.1016/j.ciresp.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 12/03/2016] [Accepted: 12/05/2016] [Indexed: 11/19/2022]
Affiliation(s)
- David Fernández-SanMillán
- Servicio de Cirugía General y Digestiva, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, España.
| | - Eudaldo López-Tomassetti Fernández
- Servicio de Cirugía General y Digestiva, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, España
| | - Juan Ramón Hernández Hernández
- Servicio de Cirugía General y Digestiva, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, España
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Landisch RM, Colwell RC, Densmore JC. Infant gastrostomy outcomes: The cost of complications. J Pediatr Surg 2016; 51:1976-1982. [PMID: 27678507 DOI: 10.1016/j.jpedsurg.2016.09.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/12/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Comparative outcomes of enhanced percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) have not been elucidated in infants. We describe the outcomes and procedural episodic expenditures of PEG versus LG in this high-risk population. METHODS One hundred eighty-three gastrostomies in children under 1year were reviewed from our institution spanning 1/2011-6/2015. Pertinent demographics and 3-month complications (mortality, gastrocolic fistula, reoperation, cellulitis, granulation, pneumonia, and tube dislodgement <6weeks) were collected. Facility and professional administrative data was used to conduct a charge and cost analysis of PEG and LG procedures as well as their statistically significant complications. RESULTS Seventy-eight PEG and 105 LG infants were compared. LG infants were significantly younger, had higher ASA class, and increased frequency of cardiopulmonary disease. Significant major complications included a 3.8% incidence of gastrocolic fistula among PEGs (3.8% vs 0%, p=0.04) and 7.6% early tube dislodgements among LG infants (0 vs. 7.6%, p=0.01), resulting in $86,896 of additional charges with PEG complication. Incorporating complication frequency, average charges and variable cost per case were $8964 and $253 greater using PEG. CONCLUSIONS Despite a healthier cohort, infants undergoing enhanced PEG have more morbid and costly complications. LG may be the less burdensome approach to gastrostomy in infants. LEVEL OF EVIDENCE Case-Control Study/Retrospective Comparative Study - Level III.
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Affiliation(s)
- Rachel M Landisch
- Children's Research Institute and Children's Hospital of Wisconsin, Milwaukee, WI 53226; Medical College of Wisconsin, Milwaukee, WI 53226.
| | - Ryan C Colwell
- Children's Research Institute and Children's Hospital of Wisconsin, Milwaukee, WI 53226
| | - John C Densmore
- Children's Research Institute and Children's Hospital of Wisconsin, Milwaukee, WI 53226; Medical College of Wisconsin, Milwaukee, WI 53226
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A Silent and Chronic Complication of Percutaneous Endoscopic Gastrostomy Tube: Small Bowel Enterocutaneous Fistula. Case Rep Gastrointest Med 2016; 2016:5328240. [PMID: 27891266 PMCID: PMC5116343 DOI: 10.1155/2016/5328240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/17/2016] [Indexed: 11/17/2022] Open
Abstract
Percutaneous endoscopic gastrostomy (PEG) has gradually gained the popularity since its invention and become the most preferred method for gastrostomy insertion in recent years. PEG is associated with lower morbidity and mortality and has the advantages of being minimally invasive and more convenient over the conventional open gastrostomy. However, significant rates of major complication still occur. Enterocutaneous fistula is one of the key complications that can be easily neglected due to its asymptomatic nature. We present a case of small bowel enterocutaneous fistula which was only found 8 years after the PEG insertion, being diagnosed after the longest duration of delay in diagnosis reported in literature.
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Kato K, Iwasaki Y, Onodera K, Matsuda M, Higuchi M, Kato K, Kato Y, Taniguchi M, Furukawa H. Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Combined with CT-GC. J INVEST SURG 2016; 30:193-200. [PMID: 27700181 DOI: 10.1080/08941939.2016.1232451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. MATERIALS AND METHODS In total, seven high-risk individuals diagnosed using computed tomography (CT)-gastrocolonography (GC) underwent laparoscopic-assisted PEG (LAPEG) placement. Study endpoints included the success of LAPEG under local anesthetic and intravenous sedation, inability to thread the PEG tube, the eventual tube location, the number of tube adjustments needed, adverse events, the operating time, and PEG tube-related infection. RESULTS In total, 135 PEG procedures were performed during this study. Successful CT-GC was achieved in all 135 patients, and we successfully used a standard PEG technique to place the gastrostomy tube in 128 patients (95%). In seven patients (5%), the LAPEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. LAPEG procedure-related minor complications were observed in two patients. CONCLUSIONS LAPEG combined with CT-GC can be used for patients with difficult anatomical orientations and may minimize the risk of complications in PEG placement.
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Affiliation(s)
- Kazuya Kato
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Yoshiaki Iwasaki
- b Department of Gastroenterology and Hepatology , Okayama University , Okayama , Japan
| | | | - Minoru Matsuda
- d Department of Surgery , Nihon University , Tokyo , Japan
| | - Mineko Higuchi
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Kimitaka Kato
- a Department of Surgery , Pippu Clinic , Hokkaido , Japan
| | - Yurina Kato
- e Department of Oral Surgery , Jikei University , Tokyo , Japan
| | - Masahiko Taniguchi
- f Department of Surgery , Asahikawa Medical University , Asahikawa , Japan
| | - Hiroyuki Furukawa
- f Department of Surgery , Asahikawa Medical University , Asahikawa , Japan
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Kapadia MZ, Joachim KC, Balasingham C, Cohen E, Mahant S, Nelson K, Maguire JL, Guttmann A, Offringa M. A Core Outcome Set for Children With Feeding Tubes and Neurologic Impairment: A Systematic Review. Pediatrics 2016; 138:peds.2015-3967. [PMID: 27365302 DOI: 10.1542/peds.2015-3967] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Uncertainty exists about the impacts of feeding tubes on neurologically impaired children. Core outcome sets (COS) standardize outcome selection, definition, measurement, and reporting. OBJECTIVE To synthesize an evidence base of qualitative data on all outcomes selected and/or reported for neurologically impaired children 0 to 18 years living with gastrostomy/gastrojejunostomy tubes. DATA SOURCES Medline, Embase, and Cochrane Register databases searched from inception to March 2014. STUDY SELECTION Articles examining health outcomes of neurologically impaired children living with feeding tubes. DATA EXTRACTION Outcomes were extracted and assigned to modified Outcome Measures in Rheumatology 2.0 Filter core areas; death, life impact, resource use, pathophysiological manifestations, growth and development. RESULTS We identified 120 unique outcomes with substantial heterogeneity in definition, measurement, and frequency of selection and/or reporting: "pathophysiological manifestation" outcomes (n = 83) in 79% of articles; "growth and development" outcomes (n = 13) in 55% of articles; "death" outcomes (n = 3) and "life impact" outcomes (n = 17) in 39% and 37% of articles, respectively; "resource use" outcomes (n = 4) in 14%. Weight (50%), gastroesophageal reflux (35%), and site infection (25%) were the most frequently reported outcomes. LIMITATIONS We were unable to investigate effect size of outcomes because quantitative data were not collected. CONCLUSIONS The paucity of outcomes assessed for life impact, resource use and death hinders meaningful evidence synthesis. A COS could help overcome the current wide heterogeneity in selection and definition. These results will form the basis of a consensus process to produce a final COS.
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Affiliation(s)
- Mufiza Z Kapadia
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences,
| | - Kariym C Joachim
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
| | - Chrinna Balasingham
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
| | - Eyal Cohen
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; and
| | - Sanjay Mahant
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; and
| | - Katherine Nelson
- Division of Paediatric Medicine, Institute of Health Policy, Management and Evaluation, and Paediatric Advanced Care Team, Department of Paediatrics, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, and Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Martin Offringa
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
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Suksamanapun N, Mauritz FA, Franken J, van der Zee DC, van Herwaarden-Lindeboom MY. Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis. J Minim Access Surg 2016; 13:81-88. [PMID: 27251841 PMCID: PMC5363129 DOI: 10.4103/0972-9941.181776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) and laparoscopic-assisted gastrostomy (LAG) are widely used in the paediatric population. The aim of this study was to determine which one of the two procedures is the most effective and safe method. METHODS: This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement. Primary outcomes were success rate, efficacy of feeding, quality of life, gastroesophageal reflux and post-operative complications. RESULTS: Five retrospective studies, comparing 550 PEG to 483 LAG placements in children, were identified after screening 2347 articles. The completion rate was similar for both procedures. PEG was associated with significantly more adjacent bowel injuries (P = 0.047), early tube dislodgements (P = 0.02) and complications that require reintervention under general anaesthesia (P < 0.001). Minor complications were equally frequent after both procedures. CONCLUSIONS: Because of the lack of well-designed studies, we have to be cautious in making definitive conclusions comparing PEG to LAG. To decide which type of gastrostomy placement is best practice in paediatric patients, randomised controlled trials comparing PEG to LAG are highly warranted.
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Affiliation(s)
- Nutnicha Suksamanapun
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Femke A Mauritz
- Department of Pediatric Surgery, Wilhelmina Children's Hospital; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Josephine Franken
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Computed tomography-gastro-colonography for percutaneous endoscopic gastrostomy using a helical computed tomography. Am J Surg 2015; 210:374-81. [PMID: 25912624 DOI: 10.1016/j.amjsurg.2014.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/04/2014] [Accepted: 10/11/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) tubes, their placement may be associated with a variety of complications, including gastrocolic fistula. METHODS In total, 48 individuals underwent computed tomography-gastro-colonography (CT-GC)-guided PEG placement. Study end points included success of CT-GC, inability to thread the PEG tube, the eventual tube location, tube adjustments needed, adverse events, operating time, and PEG tube-related infection. RESULTS A successful CT-GC was achieved in all 48 patients (100%), and we successfully used a standard PEG technique to place the gastrostomy tube in 44 patients (92%). In 4 patients (8%), the laparoscopic-assisted PEG technique was used because the transverse colon became interposed between the abdominal wall and the anterior wall of the stomach. The overall procedure-related minor complication rate was 8%. CONCLUSION CT-GC is an optional method for the estimation of intra-abdominal, anatomical orientations that may minimize the risk of complications before PEG placement.
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Tugwell J, Brennan P, OShea C, ODonoghue K, Power T, OShea M, Griffiths J, Cahill R, Cantillon-Murphy P. Electropermanent Magnetic Anchoring for Surgery and Endoscopy. IEEE Trans Biomed Eng 2015; 62:842-8. [DOI: 10.1109/tbme.2014.2366032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Use of a novel laparoscopic gastrostomy technique in children with severe epidermolysis bullosa. J Pediatr Gastroenterol Nutr 2014; 58:621-3. [PMID: 24792630 DOI: 10.1097/mpg.0000000000000256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Supplementing nutrition in children with severe epidermolysis bullosa (EB) is challenging because of skin and mucosal fragility. Percutaneous endoscopic gastrostomy is contraindicated in EB, whereas more invasive open surgical gastrostomy placement can be complicated by chronic leakage. The aim of the study was to review the efficacy and acceptability, in children with severe EB, of our modified 2-port laparoscopic approach using the Seldinger technique with serial dilatation and tube insertion through a peel-away sheath. METHODS Retrospective review of children with EB who underwent laparoscopic feeding gastrostomy at our centre since 2009. RESULTS Seven children (6 severe generalised recessive dystrophic EB, 1 non-Herlitz junctional EB; 2 girls, 5 boys) underwent modified laparoscopic gastrostomy placement at median age 4.85 years (range 1.0-8.8), with fundoplication for gastro-oesophageal reflux in 1 case, with follow-up for 0.3 to 3.9 years. The procedure was well tolerated with oral feeds usually given after 4 hours and whole protein gastrostomy feeds within 24 hours in 6 patients. Improved growth was reflected in mean weight and height z scores: -1.36 (range -2.6 to 0.5) to -0.61 (range -2.34 to 2.0) and -1.09 (range -2.42 to 1.0) to 0.71 (range -1.86 to 1.0), respectively. Postoperatively, 5 patients experienced minor local complications: minimal leakage without skin damage in 3 and transient peristomal granulation rapidly responsive to topical treatment in 2; this followed acute gastrostomy site infection in 1. There was no leakage after the immediate postoperative period. CONCLUSIONS We conclude that our less-invasive laparoscopic gastrostomy technique is effective and better tolerated in children with severe EB, at least in the medium term, than open gastrostomy placement. Longer follow-up is required.
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Shimizu Y, Okuyama H, Sasaki T, Nose S, Saka R. Laparoscopic-assisted percutaneous endoscopic gastrostomy: a simple and efficient technique for disabled elderly patients. JPEN J Parenter Enteral Nutr 2013; 38:475-80. [PMID: 23520134 DOI: 10.1177/0148607113481476] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE Percutaneous endoscopic gastrostomy (PEG) is a simplified catheter placement procedure for alimentation. Although the endoscopic approach to gastrostomy tube placement is a safe and well-tolerated procedure in most patients, the PEG procedure is difficult in elderly patients disabled since childhood who have severe scoliosis and malpositioning of the stomach. We describe a simple and effective laparoscopic-assisted PEG (LAPEG) technique that can be used for catheter placement in severely disabled patients. METHODS Thirteen severely disabled patients aged 14-57 years underwent gastrostomy tube placement with the LAPEG technique. After general anesthesia was achieved, an endoscope was placed into the stomach. Then, a 5-mm camera port was inserted at the umbilicus, and a 3-mm working port was inserted to identify and lift the optimal site for gastrostomy tube placement. After the 4-point fixation of the stomach, the 20-Fr gastrostomy tube was placed under endoscopic and laparoscopic observation. RESULTS All patients tolerated the procedure well, and there were no major complications. The procedure was successful, and all patients could feed via the tube. CONCLUSIONS Elderly disabled patients who have been bedridden since childhood often have severe scoliosis and malpositioning of the stomach. Our LAPEG procedure is effective, well tolerated, and safe for gastrostomy tube placement in such elderly patients.
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Affiliation(s)
- Yoshiyuki Shimizu
- Department of Pediatric Surgery, Hyogo College of Medicine, Hyogo, Japan
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16
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Blomberg J, Lagergren J, Martin L, Mattsson F, Lagergren P. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroenterol 2012; 47:737-42. [PMID: 22471958 DOI: 10.3109/00365521.2012.654404] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Insertion of a percutaneous endoscopic gastrostomy (PEG) is an increasingly common procedure in patients with nutritional needs and dysphagia. Better knowledge of rates and patterns of complications after PEG might influence decision-making. MATERIAL AND METHODS The objective was to prospectively evaluate the rate of six pre-defined complications (leakage, diarrhea, constipation, abdominal pain, fever and peristomal infection) and mortality occurring within 2 months after PEG in an unselected sample of patients. All patients (n = 484) who had a PEG inserted at the hospital during the study period were included. Kaplan-Meier curves were used to estimate mortality over the first 60 days following PEG and Fisher's exact test was used to test equality of proportions. RESULTS Of the 484 patients included, 85 (18%) died within 2 months after PEG insertion. The risk of early mortality was higher in the group with neurological disease than in the group with a tumor as indication (p < 0.001). After excluding mortality, the overall complication rates at 2 weeks and 2 months were 39% and 27%, respectively. The most common complications within 2 weeks were abdominal pain (13%), peristomal infection (11%), diarrhea (11%) and leakage (10%). At 2 months the most frequent complications were diarrhea (10%), leakage (8%) and peristomal infection (6%). CONCLUSIONS In the short-term perspective, there is a substantial risk of complications, including mortality, after PEG insertion. This should be considered during clinical decision-making and when informing the patients and caregivers.
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Affiliation(s)
- John Blomberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Upper Gastrointestinal Research, Stockholm, Sweden.
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Gastrostomy insertion in the 21st century: PEG or laparoscopic? Report from a large single-centre series. Pediatr Surg Int 2012; 28:443-8. [PMID: 22476714 DOI: 10.1007/s00383-012-3079-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine whether laparoscopic-assisted gastrostomy (LAG) has superseded percutaneous endoscopic gastrostomy (PEG) based on the clinical outcomes. METHODS A retrospective study was undertaken for the period January 06-December 09. Demographic and clinical outcomes were recorded and the two groups were compared. RESULTS 164 patients were studied (PEG, n = 107; LAG, n = 57). 93.5 % of PEG patients required two general anaesthetics compared with 8 % of LAG patients. Median time to using the gastrostomy was 24 (range 0-168) h in PEG and 0 (0-96) h in LAG patients (p < 0.001). Major complications occurred in 15/107 (14 %) of PEG and 2/57 (3.5 %) of LAG patients (p = 0.05). Re-operation rate following complications was 18/107 (16.8 %) for PEG and 3/57 (5.2 %) for LAG (p = 0.05). Minor complications arose in 41/107 (38 %) of PEG and 32/57 (56 %) of LAG (p = 0.05). Post-operative hospital stay was 2 (1-40) days for PEG and 2 (0-20) days for LAG (p = 0.01). The day-case rate was 0/107 for PEG and 5/57 (9 %) for LAG. There was no gastrostomy-related mortality in the series. CONCLUSION LAG requires fewer anaesthetics, is associated with shorter time to feeding, shortened hospital stay and has a reduced risk of major complications. LAG is a very good alternative to the PEG in children.
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18
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Hwang JH, Kim HW, Kang DH, Choi CW, Park SB, Park TI, Jo WS, Cha DH. A case of endoscopic treatment for gastrocolocutaneous fistula as a complication of percutaneous endoscopic gastrostomy. Clin Endosc 2012; 45:95-8. [PMID: 22741139 PMCID: PMC3363121 DOI: 10.5946/ce.2012.45.1.95] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 02/06/2012] [Accepted: 02/07/2012] [Indexed: 01/29/2023] Open
Abstract
As a rare complication of percutaneous endoscopic gastroscopy (PEG), a gastrocolocutaneous fistula may occur after PEG placement. This paper reports an interesting case which PEG tube unintentionally penetrated transverse colon during PEG. A 72-year-old female patient who suffered from medullary infarction underwent PEG procedure for enteral nutrition, and fecal materials were observed 6 days after the procedure. Transverse colon located in antero-superior site of stomach was observed through abdominal computed tomography, and also the wrong inserted tube was found through gastroscopy and colonoscopy. Endoscopic treatment for the fistula was performed by the use of hemo-clip and detachable snare, closure of the fistula was finally confirmed 6 days after the endoscopic procedure. Therefore, the gastrocolocutaneous fistula should be considered as one of the complications of PEG when fecal material is observed through PEG tube in a few days after PEG procedure and endoscopic treatment can be feasible in this case.
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Affiliation(s)
- Jong Ho Hwang
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Dae Hwan Kang
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Choel Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Soo Bum Park
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Tae Ik Park
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Woo Sung Jo
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Dong Hyuk Cha
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
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19
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Villalona GA, Mckee MA, Diefenbach KA. Modified Laparoscopic Gastrostomy Technique Reduces Gastrostomy Tract Dehiscence. J Laparoendosc Adv Surg Tech A 2011; 21:355-9. [DOI: 10.1089/lap.2010.0201] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gustavo A. Villalona
- Section of Pediatric Surgery, Yale University School of Medicine, Yale–New Haven Children Hospital, New Haven, Connecticut
| | - Milissa A. Mckee
- Section of Pediatric Surgery, Yale University School of Medicine, Yale–New Haven Children Hospital, New Haven, Connecticut
| | - Karen A. Diefenbach
- Section of Pediatric Surgery, Yale University School of Medicine, Yale–New Haven Children Hospital, New Haven, Connecticut
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20
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Zuercher BF, Grosjean P, Monnier P. Percutaneous endoscopic gastrostomy in head and neck cancer patients: indications, techniques, complications and results. Eur Arch Otorhinolaryngol 2010; 268:623-9. [PMID: 21046412 DOI: 10.1007/s00405-010-1412-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 10/13/2010] [Indexed: 12/13/2022]
Abstract
The aim of this study was to review our experience in percutaneous endoscopic gastrostomy (PEG) performed in patients with cancer of the upper aerodigestive tract. Descriptive retrospective study of 142 patients (115 males, 27 females), mean age 62.4 years (25-84 years), with head and neck or esophageal cancer, who underwent PEG tube insertion between January 2006 and December 2008. The studied parameters were indications, success rate, rate and type of complications, and their management. Percutaneous endoscopic gastrostomy was inserted before chemoradiation therapy in 80% and during or after cancer treatment in 20% of the patients. PEG placement was possible in 137 patients (96%). Major complications were observed in 9 (7%) and minor complications in 22 (17%) of the 137 patients. Seven of the 9 patients with a major complication needed revision surgery. The mortality directly related to the procedure was 0.7%. Percutaneous endoscopic gastrostomy tube insertion has a high success rate. In patients with upper aerodigestive tract cancer, PEG should be the first choice for enteral nutrition when sufficient oral intake is not possible. Although apparently easy, the procedure may occasionally lead to severe complications. Therefore, a strict technique and knowledge of clinical signs of possible complications are mandatory.
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Affiliation(s)
- Barbara F Zuercher
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital (CHUV), 1011, Lausanne, Switzerland.
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21
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Gastrostomy insertion in children: percutaneous endoscopic or percutaneous image-guided? J Pediatr Surg 2010; 45:1153-8. [PMID: 20620311 DOI: 10.1016/j.jpedsurg.2010.02.081] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 02/22/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE Gastrostomy insertion in children can be performed in many ways, but which is the best technique remains uncertain. This study evaluates the outcome of percutaneous endoscopic gastrostomy (PEG) and image-guided gastrostomy (IG). METHODS We reviewed children who had either PEG (n = 136) inserted by pediatric surgeons or IG (n = 195) inserted by interventional radiologists in our hospital between May 2004 and July 2008. Gastrostomy-related complications were given scores ranging from 20 for major complications (eg, peritonitis, gastrointestinal bleed, and visceral injury) to 1 for minor (eg, site infection and tube migration), and total score per month of follow-up was calculated per patient. RESULTS Conversion to laparoscopic or open gastrostomy was more frequent in PEG versus IG (P = .001). Fewer PEG patients (28%) had complications than did IG (47%) (P = .001). One PEG patient developed a gastrocolic fistula. In the IG group, 2 patients had transverse colon puncture, 1 had intraperitoneal tube detachment, and 1 had upper gastrointestinal bleeding. When scored and adjusted by length of follow-up, PEG had lower scores compared with IG, indicating a better outcome (P = .03). These findings were supported by zero-inflated Poisson regression analysis. CONCLUSION Major complications were rare and observed more frequently after IG. Minor complications were observed in both procedures but were significantly less common in PEG.
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22
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Literature review comparing laparoscopic and percutaneous endoscopic gastrostomies in a pediatric population. Int J Pediatr 2010; 2010:507616. [PMID: 20300186 PMCID: PMC2836526 DOI: 10.1155/2010/507616] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 02/06/2010] [Indexed: 01/27/2023] Open
Abstract
Objective. This study compares laparoscopic and percutaneous endoscopic gastrostomy (PEG) in a paediatric population to test the hypothesis that there is a difference in the frequency of serious gastrointestinal complications between the two methods. Methods. All reports published between 1995 and 2009 on laparoscopic gastrostomy and PEG in children was included. Prospective and retrospective trials, comparing the two methods or dealing with one of them only were included. Endpoints were accidentally performed gastrointestinal fistula causing an emergency re-operation. The frequency of inadvertent gastroenteric fistulas using the two different techniques was calculated. Results. 822 publications were found when using the search terms: gastrostomy, gastrointestinal complications, and all child: 0–18 years. From these, 54 studies were extracted for this investigation. These studies reported a total of 4331 children undergoing gastrostomy operation, 1027 by using the laparoscopic technique and 3304 using the PEG technique. The number of serious gastrointestinal fistulas to colon or small bowel was 0% and .27%, respectively, P < .05. Conclusions. The results suggest that by performing laparoscopic gastrostomy in children it is possible to avoid the serious intestinal fistula complications caused by a blind puncture through the abdominal cavity when performing the PEG.
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Sathesh-Kumar T, Rollins H, Cheslyn-Curtis S. General paediatric surgical provision of percutaneous endoscopic gastrostomy in a district general hospital--a 12-year experience. Ann R Coll Surg Engl 2009; 91:404-9. [PMID: 19344554 DOI: 10.1308/003588409x391749] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION A small, but significant, number of children require long-term nutritional support. The aim of this study was to demonstrate the safety and efficacy of providing a percutaneous endoscopic gastrostomy (PEG) service for children in a district general hospital and to raise awareness of the suitability of the procedure to be performed on paediatric surgery lists in similar hospitals across the UK. PATIENTS AND METHODS A multidisciplinary paediatric nutrition team was established and all children accepted for PEG insertion between 1995 and 2007 were entered onto a database prospectively and are included in this study. PEG tubes were inserted by the standard pull-through technique under general anaesthetic. RESULTS A total of 172 procedures were performed in 76 children. The median age at first tube insertion was 3 years (range, 0.5-18 years). Length of follow-up ranged from 1 month to 12.6 years. Fifty-eight children (76%) had a neurological abnormality, the commonest being cerebral palsy. All but one procedure were performed successfully, of which 63 (37%) were new insertions, 99 change of tube, 4 changed from surgical gastrostomy and 6 from PEG to button gastrostomy. The median hospital stay was 2 days (range, 2-7 days) for new insertions and 1 day for tube changes. There were 10 (6%) early complications within 30 days, the commonest being peritubal infection (6). The 39 late complications included 16 peritubal infection/granulomata, 9 'buried bumpers', 4 worsening of gastro-oesophageal reflux disease, 2 gastrocolic fistulae, 3 gastrocutaneous fistulae and 4 tubal migration. There was no mortality. CONCLUSIONS We have demonstrated that paediatric PEG procedures and continuing management by a supporting team can be successfully and efficiently provided in the district general hospital. It should be possible for the majority of similar hospitals to provide local access and increase the availability of PEG feeding for children.
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Affiliation(s)
- T Sathesh-Kumar
- Department of Surgery, Luton and Dunstable Hospital, Luton, UK.
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Norén E, Gunnarsdóttir A, Hanséus K, Arnbjörnsson E. Laparoscopic Gastrostomy in Children with Congenital Heart Disease. J Laparoendosc Adv Surg Tech A 2007; 17:483-9. [PMID: 17705732 DOI: 10.1089/lap.2006.0119] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM The aim of this study was to study the type and frequency of complications and change in weight after a laparoscopic gastrostomy procedure in 31 children with congenital heart disease, comparing patient groups of children with univentricular and biventricular circulation, and with completed and uncompleted cardiac surgery. METHODS The method used was that of a retrospective study of all 31 children with congenital heart disease who underwent a laparoscopic gastrostomy at our center from 1995 to 2004. MAIN OUTCOME MEASURES Postoperative complications and body weight changes during follow-up were the main outcome measures used in this study. RESULTS Minor stoma-related problems were common in both groups. Two severe complications requiring an operative intervention occurred in the univentricular circulation group. Weight was normal at birth, low at the time of the gastrostomy procedure, and did not catch up completely during the follow-up period of a mean of 20 months. There were no significant differences regarding mean weight gain between the groups. CONCLUSIONS The complication rate after the laparoscopic gastrostomy procedure was higher in our patient group, compared to previously studied children with various diseases. Comparisons regarding mean weight gain between the groups showed no significant differences. The mean weight gain was low, suggesting that the energy expenditure in this patient group of children with severe congenital heart disease may be even higher than previously assumed.
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Affiliation(s)
- Erik Norén
- Department of Pediatric Surgery, University Hospital, Lund, Sweden
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25
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Backman T, Berglund Y, Sjövie H, Arnbjörnsson E. Complications of video-assisted gastrostomy in children with or without a ventriculoperitoneal shunt. Pediatr Surg Int 2007; 23:665-8. [PMID: 17487495 DOI: 10.1007/s00383-007-1930-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2007] [Indexed: 10/23/2022]
Abstract
The aim of the study was to test the hypothesis that the presence of a ventriculoperitoneal shunt (VPS) influences the frequency of postoperative complications after video-assisted gastrostomy (VAG) in children. When using a power of 80%, a critical value for significance of 5% and an assumed population-based standard deviation of 0.4, it will be required to have a sample size of at least 14 children to show that a difference of 0.6 is significant when using Student's t test for paired samples. Thus, 15 consecutive children with VPSs were included in the present study. All the children had nutritional problems and underwent a VAG operation at a tertiary care university hospital. After the operation, the children were prospectively followed up. Specially trained nurses documented all complications according to a protocol. For the purpose of comparison, we had a control group of neurologically disabled children without VPSs, matched for age and operated with VAG. The children did not present with any serious postoperative intra-abdominal complications or central nervous system infection. There was no significant difference in the frequency of minor complications between the studied group and the control group. This study did not reveal that children with VPSs who undergo a VAG button placement are at high risk for infection and subsequent shunt malfunction. They did not have more postoperative problems than a matched control group of neurologically disabled children.
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Affiliation(s)
- Torbjörn Backman
- Section for Paediatric Surgery, Department of Paediatrics, University Hospital, 221 85, Lund, Sweden
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26
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Brown S, McHugh K, Ledermann S, Pierro A. CT findings in gastrocolic fistula following percutaneous endoscopic gastrostomy. Pediatr Radiol 2007; 37:229-31. [PMID: 17171351 DOI: 10.1007/s00247-006-0373-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 11/05/2006] [Accepted: 11/12/2006] [Indexed: 11/25/2022]
Abstract
We describe the CT findings in an initially asymptomatic boy aged 2 years 9 months with a gastrocolic fistula following percutaneous endoscopic gastrostomy (PEG) placement. The findings consisted of an unusual configuration of the gastrostomy tubing on an abdominal radiograph and upper gastrointestinal study indicating the possibility of transcolic PEG placement, which was confirmed with limited section CT. This well-known and major complication following a common procedure may be recognized on plain abdominal radiography, but it has not to our knowledge been documented previously on CT in a child.
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Affiliation(s)
- Suki Brown
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK.
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27
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Kawahara H, Kubota A, Okuyama H, Shimizu Y, Watanabe T, Tani G, Hiroaki Y, Okada A. One-trocar laparoscopy-aided gastrostomy in handicapped children. J Pediatr Surg 2006; 41:2076-80. [PMID: 17161210 DOI: 10.1016/j.jpedsurg.2006.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND/PURPOSE Percutaneous endoscopic gastrostomy has become a common technique to provide nutritional support to handicapped children with swallowing disorders; however, this technique is sometimes associated with serious complications. We report a novel method of 1-trocar laparoscopy-aided gastrostomy with special reference to its influence on gastroesophageal reflux (GER). METHODS The subjects consisted of 22 profoundly handicapped children, aged from 1 to 14 years (median, 7 years). Twenty-four-hour esophageal pH monitoring was conducted preoperatively in all subjects and performed postoperatively in 12. The criteria for gastrostomy alone included no significant symptoms related to GER and distal esophageal acid exposure of less than 15%. Esophageal acid exposure was evaluated at the distal esophagus (P1) and at 10 cm proximal to P1 (P2). Stamm gastrostomy was performed by grasping the anterior gastric wall with forceps inserted through an operating channel associated with a laparoscope. Data are expressed as medians and ranges. RESULTS There were neither perioperative mortality nor life-threatening complications except the detachment of the gastrostomy in one. Esophageal acid exposure was significantly increased postoperatively compared to preoperatively at P1 (2.1% [0.0%-4.7%] vs 4.6% [0.2%-8.7%], P = .02), but did not change much at P2 (0.2% [0.0%-1.5%] vs 0.8% [0.0%-7.6%], P = .07). No patient developed postoperative symptoms related to GER. CONCLUSIONS One-trocar laparoscopy-aided gastrostomy is a feasible technique for handicapped children without symptomatic GER.
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Affiliation(s)
- Hisayoshi Kawahara
- Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka 594-1101, Japan.
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Plantin I, Arnbjörnsson E, Larsson LT. No increase in gastroesophageal reflux after laparoscopic gastrostomy in children. Pediatr Surg Int 2006; 22:581-4. [PMID: 16807719 DOI: 10.1007/s00383-006-1707-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2006] [Indexed: 11/26/2022]
Abstract
The objective of the study was to assess the influence of a laparoscopic video-assisted gastrostomy on acid gastroesophageal reflux (GER). A prospective uncontrolled study included 23 neurologically disabled children, from 10 months to 15 years of age, all with severe nutritional problems and in need of a gastrostomy. They all had a history of clinical GER problems including vomiting, choking and chest infections. A 24-h pH monitoring was used for a quantitative assessment of GER the day before surgery and 12+/-3 months (7-22 months) postoperatively. The gastrostomy was placed on the anterior wall of the stomach near the lesser curvature. The main outcome measure was the comparison of the pre- and postoperative 24-h pH monitoring and the reflux index (RI), i.e. the percentage of time with pH below 4. The results showed a non-significant reduction of RI from 6.8+/-4.5 preoperatively to 3.7+/-2.0 postoperatively. We conclude that a gastrostomy using the video-assisted technique and placing the stoma on the anterior wall of the stomach close to the lesser curvature does not cause aggravation of acid reflux.
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Affiliation(s)
- Ingrid Plantin
- Department of Paediatric Surgery, University Hospital, 221 85, Lund, Sweden
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Backman T, Arnbjörnsson E, Berglund Y, Larsson LT. Video-assisted gastrostomy in infants less than 1 year. Pediatr Surg Int 2006; 22:243-6. [PMID: 16402265 DOI: 10.1007/s00383-005-1628-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2005] [Indexed: 11/29/2022]
Abstract
The objectives of this study were to report our experience with the laparoscopic video-assisted gastrostomy technique in infants operated during their first year of life. A total of 53 infants (35 males, 18 females) aged 6 +/- 3 months, varying from 3 weeks to 11 months, underwent video-assisted gastrostomy. They were prospectively followed up. Included are infants with neurological dysfunction, chromosomal anomalies, metabolic disorders, cardiac anomalies or respiratory insufficiency. All the infants were operated under general and local anaesthesia. Gastrostomy tube feeding began within 4 h after the operation. The infants were followed with a scheduled control at 1 and 6 months postoperatively documenting complications and weight gain. The main outcome measure was the number and type of complications as well as weight gain using the age-adjusted Z-score of weight to normalize the data relative to a reference population. The weight before and 6 months after the video-assisted gastrostomy was 5.5 +/- 1.6 and 8.5 +/- 1.6 kg, respectively. The Z-score increased significantly (P < 0.001) from -2.7+/-1.5 to -1.7 +/- 1.0. This illustrates the postoperative weight gain and catch-up. Short and long-term complications included minor local wound infection, leakage around the gastrostomy tube and granuloma, but no severe complications. Our results encourage the use of video-assisted gastrostomy as a safe technique to provide a route for long-term nutritional support even in infants less than 1 year.
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Affiliation(s)
- Torbjörn Backman
- Department of Pediatric Surgery, University Hospital, 221 85 Lund, Sweden
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Arnbjörnsson E, Backman T, Berglund Y, Kullendorff CM. Closure after gastrostomy button. Pediatr Surg Int 2005; 21:797-9. [PMID: 16180004 DOI: 10.1007/s00383-005-1549-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2005] [Indexed: 11/29/2022]
Abstract
A gastrostomy device is removed from the gastrostoma when no longer needed. The aim of the study was to test the hypothesis of whether it is possible for the surgeon to decide which stoma has to be closed with a gastroraphy and which to leave for a spontaneous closure within a reasonable period of time. Out of a cohort of 321 patients, who had been operated with a video-assisted gastrostomy, we included all the 48 patients having had their gastrostomy button removed. These patients were carefully followed and the closure of the gastrostoma was registered. According to the institutional routine we waited at least 3 months after the removal of the gastrostomy device before suggesting to the child's guardians an operative closure of the stoma. In 26 patients the stoma closed within 3 months, whereas in 22 patients a surgical gastroraphy was performed. We found no differences between the two groups regarding the patients' diagnoses, the duration of the gastrostoma use or patient's age at the time of removal of the gastrostomy device. This study rejected the hypothesis of predictability of the gastrostoma closure. Thus, we recommend a routine expectance after the removal of a gastrostomy device for at least 1 month. If no spontaneous closure occurs, then a gastroraphy should be performed.
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Affiliation(s)
- Einar Arnbjörnsson
- Department of Paediatric Surgery, University Hospital, SE-221 85 LUND, Sweden.
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