Profile, recommendation criteria, and outcome of gastrostomy tube insertions in a pediatric teaching hospital
DOI:
https://doi.org/10.5935/0104-7795.20150024Keywords:
Gastrostomy, Deglutition Disorders, Nutritional SupportAbstract
Objective: To describe the profile of patients undergoing a gastrostomy, the recommendations and outcome of this insertion in a Pediatric Teaching Hospital. Method: This was a retrospective, quantitative, and descriptive study that researched the records of patients who underwent a gastrostomy between January 2010 and December 2012. Results: The diseases and conditions most frequent were chronic infantile encephalopathy (77.5%), pneumonia (67.5%), seizures (57.5%), and malnutrition (42.5%). Although most patients presented a history of dysphagia (62.5%), oral feeding was observed most frequently as the most common form of nutrition, before the gastrostomy insertion (42.5%), followed by nasoenteric tube (40%). The introduction of nutrition by gastrostomy was successful and occurred an average of 2.82 (± 1.19) days after insertion. Six months after their gastrostomy, 80% of patients continued feeding only through this access tube and only 2.5% had removed the gastrostomy; 45% of the participants had gastrostomy complications, with extravasation of gastric material (15%) and local inflammation (15%) being the most frequent. Conclusion: The profile of patients undergoing gastrostomy is mostly of individuals with neurological and respiratory diseases, without respiratory support, of the male gender, and feeding by oral cavity or nasoenteric tube for a prolonged period. The main recommendation criteria were dysphagia and neurological diseases. Regarding the outcome, the introduction of nutrition by gastrostomy was successful; most individuals remained with this long-term nutritional support and the most common complications were gastric material extravasation and local inflammations.
Downloads
References
Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980;15(6):872-5. DOI: http://dx.doi.org/10.1016/S0022-3468(80)80296-X
El-Matary W. Percutaneous endoscopic gastrostomy in children. Can J Gastroenterol. 2008;22(12):993-8.
Holmes S. Enteral feeding and percutaneous endoscopic gastrostomy. Nurs Stand. 2004;18(20):41-3. DOI:http://dx.doi.org/10.7748/ns2004.01.18.20.41.c3536
Holt AC, Clark PL 3rd. Gastrostomy in the treatment of dysphagia. Calif Med. 1965;102:280-4
Rogers B, Arvedson J, Buck G, Smart P, Msall M. Characteristics of dysphagia in children with cerebral palsy. Dysphagia. 1994;9(1):69-73. DOI: http://dx.doi.org/10.1007/BF00262762
Ackroyd R, Saincher M, Cheng S, El-Matary W. Gastrostomy tube insertion in children: the Edmonton experience. Can J Gastroenterol. 2011;25(5):265-8
Löser C, Wolters S, Fölsch UR. Enteral long-term nutrition via percutaneous endoscopic gastrostomy (PEG) in 210 patients: a four-year prospective study. Dig Dis Sci. 1998;43(11):2549-57. DOI:http://dx.doi.org/10.1023/A:1026615106348
Brewster BD, Weil BR, Ladd AP. Prospective determination of percutaneous endoscopic gastrostomy complication rates in children: still a safe procedure. Surgery. 2012;152(4):714-9. DOI: http://dx.doi.org/10.1016/j.surg.2012.07.018
Carido J, Santos C, Ferreira MG, Fonseca J. Nutrição entérica por gastrostomia endoscópica em doentes com idade pediátrica: avaliação retrospectiva em 40 doentes consecutivos. J Port Gastrenterol. 2011;18(6):273-8
Silva SV, Schmidt AF, Mezzacappa MA, Marba ST, Bustorff-Silva JM, Sbragia L. Babies with brain damage who can not swallow: surgical management. Arq Neuropsiquiatr. 2008;66(3B):641-5. DOI: http://dx.doi.org/10.1590/S0004-282X2008000500007
Cappellano G.Gastrostomia e refluxo gastroesofágico em crianças neuropatas. Einstein. 2003; 1:117-23.
Mahant S, Jovcevska V, Cohen E. Decision-making around gastrostomy-feeding in children with neurologic disabilities. Pediatrics. 2011;127(6):e1471-81. DOI: http://dx.doi.org/10.1542/peds.2010-3007
Fortunato JE, Troy AL, Cuffari C, Davis JE, Loza MJ, Oliva-Hemker M, et al. Outcome after percutaneous endoscopic gastrostomy in children and young adults. J Pediatr Gastroenterol Nutr. 2010;50(4):390-3.
Akay B, Capizzani TR, Lee AM, Drongowski RA, Geiger JD, Hirschl RB, et al. Gastrostomy tube placement in infants and children: is there a preferred technique? J Pediatr Surg. 2010;45(6):1147-52.
Nogueira SCJ, Carvalho APC, Melo CB, Morais EPG, Chiari BM, Gonçalves MIR. Perfil de Pacientes em uso de via alternativa de alimentação internados em um hospital geral. Rev CEFAC. 2013;15(1):201-12. DOI:http://dx.doi.org/10.1590/S1516-18462012005000079
Chong VH, Vu C. Percutaneous endoscopic gastrostomy outcomes: can patient profiles predict mortality and weaning? Singapore Med J. 2006;47(5):383-7.
Ney DM, Weiss JM, Kind AJ, Robbins J. Senescent swallowing: impact, strategies, and interventions. Nutr Clin Pract. 2009;24(3):395-413. DOI: http://dx.doi.org/10.1177/0884533609332005
Gomes GF. Identificação de fatores preditivos de pneumonia aspirativa em pacientes hospitalares com doença cerebrovascular complicada por disfagia orofaríngea [Dissertação]. Curitiba: Universidade Federal do Paraná; 2001.
Correia SM, Morillo LS, Jacob Filho W, Mansur LL. Swallowing in moderate and severe phases of Alzheimer’s disease. Arq Neuropsiquiatr. 2010;68(6):855-61. DOI: http://dx.doi.org/10.1590/S0004-282X2010000600005
Barros APB, Portas JG, Queija DS. Implicações da traqueostomia na comunicação e na deglutição. Rev Bras Cir Cabeça e Pescoço. 2009;38(3)202-7.
Srinivasan R, Fisher RS. Early initiation of post-PEG feeding: do published recommendations affect clinical practice? Dig Dis Sci. 2000;45(10):2065-8.
Choudhry U, Barde CJ, Markert R, Gopalswamy N. Percutaneous endoscopic gastrostomy: a randomized prospective comparison of early and delayed feeding. Gastrointest Endosc. 1996;44(2):164-7. DOI: http://dx.doi.org/10.1016/S0016-5107(96)70134-7
Crosby J, Duerksen DR. A prospective study of tube- and feeding-related complications in patients receiving long-term home enteral nutrition. JPEN J Parenter Enteral Nutr. 2007;31(4):274-7. DOI: http://dx.doi.org/10.1177/0148607107031004274
Siddique I, Krishnamurthy M, Choubey S, Gudavalli P, Bharathan T, Pachter BR. Colocutaneous fistula: a rare and silent complication of percutaneous endoscopic gastrostomy. Dig Dis Sci. 1996;41(2):301-4. DOI: http://dx.doi.org/10.1007/BF02093819
Fein PA. Safety of PEG tubes in peritoneal dialysis patients. Semin Dial. 2002;15(3):213-4.
Downloads
Published
Issue
Section
License
Copyright (c) 2015 Acta Fisiátrica
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.