Mitigation of stomach dehiscence risk during gastrostomy tube changes - a retrospective analysis of patient outcomes.
BACKGROUND
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 7.59years and an average site age of 3.43years. 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.


METHODS
Study of diagnostic test level II.
Research Intern, Great Lakes Pediatric Surgeons, Inc., Fort Wayne, IN 46804, USA. Electronic address: eblochersmith756@marian.edu.
Ethan Charles
EC
Blocher-Smith
Great Lakes Pediatric Surgeons, Fort Wayne, IN 46804, USA. Electronic address: smithda@cfaith.com.
David A
DA
Smith
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D013272:Stomach Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013396:Suction; D016896:Treatment Outcome; D055815:Young Adult
Complication of gastrostomy placement; Gastric aspirate; Gastric dehiscence; Gastrostomy tube change