Page 133 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

Chapter 8
The frequently reported minor complications encountered after GP often result in increased health care utilization, significant discomfort and frequent hospital consultations. 17 Indication for GP must therefore be set carefully. However, most pediatric patients undergoing GP are dependent on enteral feeding through a gastrostomy tube. 18 Consultations with a specialized outpatient care unit and stoma care nurses are important for adequate treatment of leakage and infections and replacement of the catheter in case of dislodgement. In case of persisting symptoms of feeding intolerance or leakage at the gastrostomy site, timely assessment should take place for possible indication for a gastrojejunostomy, or in severe cases, for laparoscopic jejunostomy placement.
Analyzing clinical effects of GP in children, some difficulties are encountered. First, our study population is particularly heterogeneous with various, often co-existing, morbidities. Such patient heterogeneity can be viewed as a strength because it adds generalizability to the results and consequently, results can be applied to all patients. However, it can also lead to variability in results and, in case of small samples sizes, limit the power of the studies. Particularly in analysis of gastrointestinal function we must take into account that children may have altered gastrointestinal function because of their underlying medical conditions. The influence of GP on gastrointestinal function in the different morbidity groups might consequently differ.
Second, during the research involving clinical measurements significant loss to follow-up was encountered. In most cases the reason was either inability of patients to undergo the postoperative tests because of illness, or refusal by parents because they considered the tests as too much of an additional burden alongside of the fixed hospital visits. The burden of care in this vulnerable group of children makes research challenging and, at the same time, all the more necessary.
In analysis of gastric motility after GP, the cause for the postoperative delay in GE is not evident. Slow contractions of the fundus are believed to transfer gastric contents from the fundus to the antrum for trituration and subsequent GE. 22 These contractions might be affected by GP in the gastric body. Motility tests such as three-dimensional ultrasonography or dynamic contrast-enhanced magnetic resonance imaging of the stomach may be useful to clarify this matter. Analysis in a larger study population is required to provide more certainty on the role of delayed GE in the occurrence of postoperative complications.
Several previous studies have stated that GP effectuates GER. 11 However, caution is needed when determining causality between GP and GER, because of the multifactorial pathophysiology of GER. 23 Consequently, multiple possible confounders can influence results of GER measurement. Moreover, studies were of insufficient methodological quality
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