title: Gastrocutaneous fistula in children after removal of gastrostomy tube: incidence and predictive factors.
abstract: OBJECTIVE
  Removal of a gastrostomy tube may result in a persistent gastrocutaneous fistula. The authors reviewed their experience to determine the incidence of this event in children, and the factors that contribute to its occurrence.
  
  
  METHODS
  Over a 3-year period, 32 children had a gastrostomy tube placed that was subsequently removed. Of these, 18 sites closed spontaneously and 14 had a persistent gastrocutaneous fistula (44%). The groups were similar with respect to age, sex, and diagnosis. Mean time from insertion to removal of the tube was 6.5+/-2 months in the group with spontaneous closure, and 29.8+/-8 months in the gastrocutaneous fistula group (P<.05).
  
  
  RESULTS
  One of 17 (6%) children who had tubes removed within 8 months of insertion had a fistula, compared with 13 of 15 (87%) of those who had one removed after 9 or more months (P<.001). Patients with tubes inserted percutaneously (PEG) were less likely to have a fistula than those using the Stamm technique (28% v. 55%, not significant), although PEGs also tended to be in place for a shorter time before removal (12.6 v. 21.1 months). Steroids did not increase the likelihood of a fistula (50% v. 42%, not significant).
  
  
  CONCLUSIONS
  The incidence of persistent gastrocutaneous fistula is high after gastrostomytube removal in children. The most important factor predisposing to this problem appears to be the length of time the tube is in place before its removal. Almost all tubes removed within 8 months will close spontaneously.
authors.affiliation: Division of Pediatric Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Gordon
authors.forename: J C
authors.initials: JC
authors.lastname: Langer
mesh_terms: D002675:Child, Preschool; D017577:Cutaneous Fistula / Q000209:etiology*; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D005747:Gastric Fistula / Q000209:etiology*; D005774:Gastrostomy; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D012189:Retrospective Studies