Page 63 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

inTRoDUCTion
A gastrostomy placement (GP) is frequently performed in pediatric patients to provide prolonged enteral tube feeding. Although GP is a common procedure, the effects of the operation on gastric motility are unknown. In the majority of patients a GP is successful, because in time, sufficient caloric intake can be provided through the gastrostomy. 1,2 However, in an estimated 15-25% of patients a gastrostomy fails, leading to intolerance of feeding and leakage at the gastrostomy site. 3,4 It is unclear whether these complications may be due to delayed gastric emptying (DGE) after operation. Based on current evidence, it is unknown which patients are at risk of gastrostomy failure. 5,6
Another, widely discussed, complication of GP is the development or deterioration of gastroesophageal reflux (GER). GER is frequently associated with abnormal gastric motility. 7,8 DGE after GP may therefore be associated with postoperative GER. Hence, the importance of investigating GP and gastric motility.
In adults, the effect of a GP on gastric emptying (GE) has been investigated by two studies, detecting no significant changes in GE after operation. 9,10 In children, only one retrospective study on GP and GE was performed, including 26 patients. 11 This study was conducted with the 13C-octanoic acid gastric emptying breath test (13CGEBT) and detected no significant changes in GE after operation. This 13CGEBT is a reliable, safe and non-invasive diagnostic method for GE in children. 12 No prospective studies on GE before and after GP in children have been performed to date.
The aim of this study was to evaluate the effect of GP on GE in children using the non- invasive 13CGEBT and to identify parameters predictive of gastrostomy failure.
MeTHoDs
study design
A prospective, longitudinal cohort study including 50 pediatric patients was performed. Between May 2012 and April 2014, all children (aged 0-18 years) referred for GP to the Wilhelmina Children’s Hospital were considered for participation. Patients with a history of gastric surgery, with structural abnormalities of the stomach or who were unable to undergo the assessment tests were excluded from the study.
Chapter 4
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