Background In the past, gastrostomy tubes had to be inserted laparoscopically, however recently the trend has shifted to favour the use of percutaneous endoscopic gastrostomies, otherwise known as PEG tubes. Major indications for this procedure include gastric motility disorders, severe reflux as well as an unsafe swallow due to neurological impairment. The PEG tube is also a valuable tool in paediatric care since it can be performed without anaesthetics and provides a viable route for feeding children who are unable to tolerate oral intake.
Objectives To determine the safety of radiologically inserted feeding tubes by assessing outcomes, specifically looking at rates and nature of complications.
Methods A retrospective review was carried out on the hospital records for gastrostomy, gastrojejunostomy and jejunostomy procedures performed between May 1st 2018- May 1st 2019, for all paediatric patients (under 18s) at St. George’s hospital, London. Records for the procedures were documented by the operating surgeons. General hospital admissions were also reviewed for any follow up complications post procedure. The final cohort size included 28 procedures performed on 14 children.
Results Between May 1st 2018 and May 1st 2019, 28 gastrostomy procedures were performed on 14 children (mean age 6.07 years, range 1–16 years). 9 out of 14 children had neurological impairment (global developmental delay, cerebral palsy etc.), while the other 5 children had GI disorders. 67.9% (19/28) of procedures were carried out without the use of sedatives, 21.4% (6/28) under general anaesthetic and 7.1% (2/28) using a combination of local and general anaesthesia. No intra-operative complications were observed for any of the 28 procedures, however 2 procedures were noted to be difficult due to intestinal malrotation. Mechanical damage (breakage, leakage and displacement) was the most common complication found (18 cases). Other findings included 4 cases of post-operative weight loss due to intolerance to feeding, and 1 case of post-operative decline. 3 patients are deceased, the cause of death being cardiac arrest unrelated to the procedure.
Conclusions The results show that the technical success rate of PEG procedures was 100%, represented by tube functionality in all 28 cases post-operatively. The only reported major complication was a post-operative decline which subsequently resolved after ICU admission. The rate of minor complications was significantly higher at 24 cases, including tube breakage, leaks and misplacements. Most of these minor complications occur by accident e.g. a child pulling out the PEG tube. PEG tubes also have the advantage of not requiring anaesthesia, and the procedures were well tolerated by the children.
Therefore, radiologically inserted gastrostomies are a safe alternative to outdated laparoscopic techniques. These procedures can be carried out with little difficulty and possess a low rate of major complications.
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