Page 45 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

inTRoDUCTion
The placement of a gastrostomy tube is an established treatment to benefit pediatric patients with feeding difficulties by providing enteral feeding directly into the stomach. The majority of these children have significant neurological impairment.1 Less frequently occurring indications for gastrostomy placement are inadequate caloric intake in children with chronic medical conditions, failure to thrive, dysphagia, short bowel syndrome and malabsorption.2-4 Currently, gastrostomy placements are performed by minimally invasive techniques, either via laparoscopic gastrostomy placement (LGP) or percutaneous endoscopic gastrostomy (PEG). The LGP is the standard approach in our institution, mainly because it is thought that LGP obviates the need for a second procedure using general anesthesia to change the gastrostomy catheter to a button, has a lower complication rate and is associated with shorter hospital stay when compared to PEG. 5,6
The two most important aims when placing a gastrostomy are improvement of nutritional status 7,8 and improvement of quality of life (QoL). Achievement of these aims is determined by efficacy of enteral feeding via the gastrostomy and possible adverse events associated with the gastrostomy. 8,9
Frequently reported adverse events associated with gastrostomy placement are hypergranulation tissue, leakage of gastric contents at the gastrostomy site and gastrostomy site infections. 10,11 These complications are not life-threatening. However, they are associated with increased health care utilization. 11 Well-designed studies reporting on these adverse events are limited, as is shown in a recent systematic review. 9
Another possible adverse effect of a gastrostomy placement is gastroesophageal reflux (GER). GER symptoms are seen in 25–66% of patients after gastrostomy placement. 3,12,13 Until now, only a few studies have performed 24-hour pH monitoring to obtain objective data on GER before and after gastrostomy placement. Some authors advocate the routine use of preoperative 24-hour pH monitoring to predict postoperative GER. 13,14 In these studies, patients with preoperative pathological reflux more often developed postoperative GER symptoms after LGP requiring antireflux surgery (ARS). However, two other studies using 24-hour pH monitoring both before and after gastrostomy placement could not identify an increase in pathological GER. 15,16
These conflicting study results about the efficacy of gastrostomy feeding and possible adverse events after LGP may hinder the decision-making process for caregivers and physicians. The aim of this study is, therefore, to evaluate the long-term efficacy and
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