title: Factors Affecting Spontaneous Closure of Gastrocutaneous Fistulae After Removal of Gastrostomy Tubes in Children With Intestinal Failure.
abstract: BACKGROUND
  Children with intestinal failure (IF) frequently require gastrostomy tubes (GTs) for long-term nutrition support. Risk factors for persistent gastrocutaneous fistulae (GCFs) in pediatric patients with IF are largely unknown but may include underlying nutrition status and duration of indwelling GT.
  
  
  METHODS
  Records of patients with IF having undergone GT removal and allowed a trial at spontaneous closure were reviewed. Nonparametric continuous variables were analyzed using the Wilcoxon rank sum test. Post hoc analysis was performed to identify the optimal threshold of GT duration predicting probability of spontaneous closure identified using receiver operating characteristic curve analysis.
  
  
  RESULTS
  Fifty-nine children with IF undergoing GT removal were identified. Spontaneous closure occurred in 36 (61%) sites, while 23 (39%) underwent operative closure at a median 67 days after GT removal. The duration of indwelling GT was significantly shorter in the spontaneous closure group (11.5 vs 21 months, P = .002). Of 33 GT indwelling for ≤ 18 months, 28 (85%) closed spontaneously, compared with only 9 of 26 (35%) with duration >18 months (P < .001). With GCF persisting beyond 7 days, only 21% (6/28) of sites closed spontaneously, but this dropped to 6% (1/18) of cases with concurrent GT duration >18 months.
  
  
  CONCLUSIONS
  Of the risk factors evaluated, only prolonged GT duration was associated with an increased likelihood of failure to close spontaneously. It is significantly less likely in pediatric patients with IF in whom GCF persists >7 days, particularly if the duration of GT is >18 months. Relatively earlier operative closure should be considered in this group.
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Faraz A
authors.initials: FA
authors.lastname: Khan
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Fisher
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Sparks
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Julie
authors.initials: J
authors.lastname: Iglesias
authors.affiliation: Department of Surgery, Department of Biostatistics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Biren P
authors.initials: BP
authors.lastname: Modi
authors.affiliation: Division of Gastroenterology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.affiliation: Center for Advanced Intestinal Rehabilitation, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts Tom.Jaksic@childrens.harvard.edu.
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
mesh_terms: D002675:Child, Preschool; D005747:Gastric Fistula / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007410:Intestinal Diseases / Q000601:surgery*; D007422:Intestines / Q000601:surgery; D016015:Logistic Models; D009752:Nutritional Status; D012307:Risk Factors
keywords: enteral access; life cycle; neonates; nutrition; pediatrics