Review Article
Mitigation of stomach dehiscence risk during gastrostomy tube changes – a retrospective analysis of patient outcomes

https://doi.org/10.1016/j.jpedsurg.2016.09.004Get rights and content

Abstract

Introduction

Stomach dehiscence from the abdominal wall is a serious and potentially life-threatening complication of gastrostomy tube changes. This retrospective study evaluates gastric aspiration as an inexpensive and safe alternative to endoscopic or radiographic confirmation.

Methods

From August 1998 to June 2016, 682 patients (301 female, 381 male) underwent 1713 gastrostomy tube changes in the medical setting, with an average age of 7.59 years and an average site age of 3.43 years. The most common diagnoses were GERD (304), aspiration (168), and failure to thrive (143).

Results

All newly inserted tubes were aspirated to visually inspect for gastric fluid. This procedure as a confirmatory test for intragastric placement was found to have a positive predictive value of 99.5% and negative predictive value of 77.8%, with a sensitivity of 99.8% and specificity of 63.6%. In cases with successful aspiration of gastric fluid, 75.5% of changes resulted in no complications, with intraperitoneal insertion or leak in only 0.48% of cases.

Conclusions

Positive gastric aspirate is a strong predictor of proper G-tube placement with high sensitivity, eliminating the requirement of specialized equipment and the cost associated with endoscopic or radiographic guidance, and has a comparable or superior risk profile.

Levels of evidence

Study of diagnostic test level II.

Section snippets

Methods

Records of all patients that underwent G-tube changes through GLPS were retrospectively reviewed for an almost 18-year period between August 1998 and June 2016. All procedures were performed by the senior author in the GLPS office, at Lutheran Hospital, or Parkview Hospital in Fort Wayne, IN. All procedures that included complex tubes, such as GJ, NJ, or J-tubes, were excluded from the data pool. Demographics and related complications were abstracted from the medical records. Data collected

Results

There was no significant difference for any conversion class based on age of patient or gender. Conversions of PEG tubes vs. other tube types occurred at a significantly younger age of site (p < 0.0001), consistent with accepted trends and recommendations of using PEG tubes for initial insertion followed by change after one month, as illustrated in Fig. 1.

Overall, the changes showed a 1.28% rate of severe complication, as seen in Fig. 2 and Table 2. PEG changes showed a higher overall

Complications of button gastrostomy tube changes

Balloon tipped button gastrostomy tubes are popular because of their ease of tube exchange. These tubes last 6–9 months, requiring more frequent changes versus the mushroom tipped button tubes that last 18 months to 2 years. Increased expense related to frequent tube changes is often justified by zealous sales representatives citing less risk to the patient during the exchanges of balloon tubes. Our study demonstrates that there is no significant difference in any complication class between

Funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgements

Great Lakes Pediatric Surgeons, Inc. staff for their assistance with charts.

1

Present Address: Student, Marian University College of Osteopathic Medicine, 3200 Cold Spring Road, Indianapolis, IN 46222 USA.

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