Page 13 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

Chapter 1
Adverse events
Perioperative complications during GP are adjacent bowel injury and upper gastrointestinal bleeding. Other major complications are tube migration and intraperitoneal leakage of tube contents because of dehiscence of the gastric wall, which if left untreated leads to sepsis. 2,20,21
Furthermore, minor complications associated with gastrostomy tube feeding frequently occur (e.g. gastrostomy site infection or tube dislodgement). Well-designed studies reporting on these complications are limited and reported complication rates vary strongly among different studies. 1,2
Gastrointestinal effects of GP
In an estimated 15–25% of patients a gastrostomy fails, characterized by intolerance of feeding with excessive vomiting and/or leakage of gastric contents at the gastrostomy site. 22 As an intermediate solution, a gastrojejunostomy tube can be placed as an extension through the gastrostomy into the jejunal part of the small intestine. 22 If a gastrojejunostomy does not alleviate symptoms, the gastrostomy can be removed, in which case a laparoscopic jejunostomy placement is performed or patients can be confined to total parenteral nutrition. Based on current evidence, it is unknown which patients are at risk of gastrostomy failure. 1,23 It is unclear whether gastrostomy failure may be associated with changes in gastric emptying rate and/or the occurrence of gastroesophageal reflux (GER) after GP.
Gastric emptying
Pediatric patients undergoing GP often suffer from profound neurologic impairment. 24 Generalized gastrointestinal dysmotility is frequently encountered in these patients. 25,26 Additionally, the effects of GP itself on gastric emptying are unknown.
Diagnosing gastric emptying: the 13C gastric emptying breath test
99-Technetium scintigraphy was former standard of care for measuring GE in children for a long period of time. In 2005 the 13C gastric emptying breath test (13CGEBT) was introduced. The test utilizes a gas isotope ratio mass spectrometer for the measurement of the ratio of 13CO2 to 12CO2 in breath samples. In contrast to 99-Technetium scintigraphy, it offers normal values for children of all ages, both genders, and liquid and solid intake.46 Additionally, 13CGEBT does not involve radiation and is therefore suitable for large pediatric study populations. 27
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