Page 115 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

inTRoDUCTion
A gastrostomy placement (GP) is an effective treatment that provides long-term enteral tube feeding in children with feeding difficulties. 1,2 The main indications for GP are neurologic impairment (NI), cystic fibrosis and congenital cardiac disease. 3,4 The pediatric patients with these aforementioned conditions can suffer from poor nutritional status, 5 which may lead to increased morbidity. Also, feeding difficulties in these patients (e.g. refusal of food or prolonged feeding time) can have a negative impact on the lives of both patients and their caregivers. 6 GP, as a guaranteed route for enteral tube feeding, may not only lead to an improvement in nutritional status, but possibly leads to an improvement in other aspects in the lives of these patients as well, thereby increasing their health-related quality of life (HRQoL).
HRQoL is increasingly recognized as an essential part of patient care outcome. It aims to assess the impact of an illness and its treatment on the dimensions of physical and psychosocial health. 7-10 To our knowledge, no study has ever prospectively evaluated the effect of GP on HRQoL. One study reported on HRQoL before and after image-guided gastrostomy or gastrojejunostomy placement in neurologically impaired children. In this study no significant changes were reported, however, this study did not use validated HRQoL questionnaires 11.
The lack of well-designed studies on GP and the effects of GP on its primary goal, improvement in HRQoL, led to the design of this study. Where the aforementioned study did not use validated questionnaires for HRQoL assessment, we used the Pediatric Quality of Life (PedsQLTM) 4.0 generic core scales. The PedsQLTM is a validated diagnostic tool in healthy children as well as in children with numerous acute and chronic medical conditions. It has been proven to be reliable for both proxy-report by caregivers and parallel self-report for children. 8-10
The primary aim of the current study is to evaluate the effect of GP on HRQoL in children prospectively. Although children in most cases have few alternatives for GP, it is important to understand the consequences of the operation on the lives of the children referred for GP, especially when providing information to caregivers. Our hypothesis is that GP in children leads to an improvement in HRQoL. We also aim to identify predictors of HRQoL and predictors of postoperative changes in HRQoL, thereby enabling us to identify the children who will gain the most benefit from GP. Finally, we investigated differences in HRQoL between self-report by patients and proxy-report by caregivers. We considered differences between proxy and self-reported HRQoL an interesting additional outcome,
Chapter 7
113