Page 132 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

In chapter 7 a prospective, longitudinal cohort study on 50 patients is described. Caregivers filled out the PedsQLTM questionnaire before and 3 months after GP. HRQoL did not significantly increase (p=0.30). However, psychosocial HRQoL increased: from 55.8 (± 20.8) to 61.2 (±19.6; p=0.03). This was mainly due to an increase in social HRQoL: 58.2 (±32.3) to 68.3 (±27.9; p=0.04). Worse preoperative nautritional status was a predictor for improvement in HRQoL after GP. Complications did not predict HRQoL (p=0.43).
Social HRQoL comprises the abilities to function as other children of the same age. Presumably, GP can help children participate in normal daily life.
General discussion and future perspectives
This thesis demonstrated that GP is successful in providing a long-lasting route for enteral tube feeding; however, GP can be associated with unanticipated dverse events.
A systematic review and meta-analysis comparing PEG and laparoscopic GP showed that the laparoscopic approach is safer since it minimizes the risk of intestinal injury. Additionally, PEG often requires repositioning of the gastrostomy tube. These findings were supported by previous studies. 15 16 and underline the hypothesis that laparoscopic GP may be preferred over PEG. However, all analyses on this subject were based on retrospective studies. A randomized controlled trial comparing PEG with laparoscopic GP would contribute to a more widely accepted consensus on the subject.
Long-term follow-up of gastrostomy feeding showed that after laparoscopic GP, weight- for-height values increased. Previous studies on catch-up growth in children recovering from malnutrition showed that weight-for-height measures are the only reliable indicator for improvement of nutritional status, as height-for-age measures are generally more delayed during catch-up growth. 19,20 These findings indicate that GP is an effective procedure.
Because GP is performed in children with pronounced nutritional problems and significant comorbidities, it remains difficult to determine the exact effect of GP itself on nutritional status. During interpretation of nutritional outcome, one should consider the possible confounding effects of dietary actions (such as preoperative method of feeding and the amount of nutritional intake), feeding regimen (continuous versus bolus feeding) and gastrostomy-related complications. Precise measurements of these confounders in a prospective cohort would give an even more precise estimate of the efficacy of GP. 21 In our prospective studies (chapters 4, 5 and 7), in which gastrointestinal function and HRQoL were primary outcomes, the follow-up time of 3 months was too short to demonstrate weight gain and perform these analyses.
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