Gastrostomy and gastrojejunostomy tube placements: outcomes in children with gastroschisis, omphalocele, and congenital diaphragmatic hernia.
OBJECTIVE
To retrospectively evaluate the technical success, safety, and outcomes of radiologically guided retrograde percutaneous gastrostomy and gastrojejunostomy tube placements in terms of weight gain and growth in children with gastroschisis, omphalocele, and/or congenital diaphragmatic hernia (CDH).


METHODS
Research ethics board approval, with waived informed patient consent, was obtained for review of the data of 37 children (17 male, 20 female; age range, 1-20 months; mean age, 4.3 months) in whom gastrostomy or gastrojejunostomy tubes were inserted between 1995 and 2004. Twenty-two patients had CDH, eight had gastroschisis, five had omphalocele, and two had both CDH and omphalocele. The technical success and complications of the procedures were recorded. Tube maintenance problems were analyzed separately from postprocedural complications. Initial and final patient growth percentiles were compared by using a one-sided paired Student t test.


RESULTS
Thirty-six of the 38 procedures performed in the 37 patients were successful. There were three intraprocedural complications (two cases of access difficulty, one case of bleeding) and three major complications (one skin and prosthetic material infection, one track loss during tube replacement, one delayed gastrostomy track closure necessitating surgery). Sixteen patients had at least one minor complication (cellulitis, feeding intolerance, skin-site bleeding, intussusception). Twenty-two patients had at least one tube maintenance problem. All patients gained weight (mean weight gain, 4.7 kg) after the procedure, with a significant increase in growth percentile (average increase, 6.5%; P = .029).


CONCLUSIONS
Radiologically guided percutaneous gastrostomy and gastrojejunostomy tube placements in children with gastroschisis, omphalocele, and/or CDH are associated with high success rates and low major complication rates. Although tube maintenance problems and minor complications are common, use of gastrostomy and gastrojejunostomy tubes effectively improves nutritional support.
Rosenberg
Jodine
J
Department of Diagnostic Imaging, Division of Image Guided Therapy, the Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada.
Amaral
Joao G
JG
Sklar
Cindy M
CM
Connolly
Bairbre L
BL
Temple
Michael J
MJ
John
Philip
P
Chait
Peter G
PG
D005260:Female; D015390:Gastric Bypass; D020139:Gastroschisis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005774:Gastrostomy; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000601:surgery*; D006554:Hernia, Umbilical / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome