REGULAR CONTENT
Final ID
527
Type
Original Scientific Research-Oral or Pos
Authors
P Skummer1, K Kobayashi1, M Jawed1, D Zhang1, M Karmel1
Institutions
1SUNY Upstate Medical University, Syracuse, NY
Purpose
Retrospectively evaluate the safety, impact on growth, and clinical outcomes of gastrojejunostomy (GJ) tubes placed via surgically-created gastrostomy in developmentally-disabled (DD) children with intolerance to gastrostomy (G) tube feeding.
Materials & Methods
Between January 2009 and June 2015, 44 DD children had successful image-guided conversion of a G tube to a GJ tube via a surgically-created gastrostomy with >30 days follow-up (M/F: 24/20, median age: 28.0 months). The most common indication for GJ tube was reflux (n=21) and the most common clinical history was neurologic (n=28). Medical records and imaging were reviewed to identify complications and record weight-for-age Z scores based on CDC's 2000 Growth Charts. Complications were classified as minor or major according to SIR guidelines. Tube maintenance issues (TMIs) were separately recorded. Fixed effects analysis of repeated measures was performed to evaluate the change in average weight-for-age z-scores over time. Clinical follow-up information was also obtained.
Results
A total of 31,378 device days (median: 634 days) were observed. 3 patients (6.8%, 0.01/100 days) had aspiration pneumonia (major complication). 63 minor complications (0.20/100 days) were seen in 31 patients (70.5%) with vomiting the most frequent (n=18). 202 TMIs (0.64/100 days) occurred in 41 patients (93.2%) with dislodgement the most frequent (n=77). There was a significant increase in mean z-score at 6 month intervals relative to mean z-score of -3.22 at conversion: 0.81 at 1-6 months (p<.001), 1.28 at 7-12 months (p<.001), 1.22 at 13-18 months (p=.001), 1.16 at 19-24 months (p=.01), and 1.39 at 25+ months (p=.01). At last clinical follow-up, 32 patients were still using a GJ tube. The remaining 12 patients had conversion back to a G tube due to tolerating oral feeding (n=6), continued dislodgement (n=1), repeated migration into esophagus (n=1), intolerance to J tube feeding (n=2), and request by a guardian (n=2).
Conclusions
GJ tube placed via surgically-created gastrostomy in DD children with intolerance to G tube feeding was a viable option to help improve weight gain and could be a bridge to oral feeding. The frequent minor complications and TMIs were a drawback.
Final ID
527
Type
Original Scientific Research-Oral or Pos
Authors
P Skummer1, K Kobayashi1, M Jawed1, D Zhang1, M Karmel1
Institutions
1SUNY Upstate Medical University, Syracuse, NY
Purpose
Retrospectively evaluate the safety, impact on growth, and clinical outcomes of gastrojejunostomy (GJ) tubes placed via surgically-created gastrostomy in developmentally-disabled (DD) children with intolerance to gastrostomy (G) tube feeding.
Materials & Methods
Between January 2009 and June 2015, 44 DD children had successful image-guided conversion of a G tube to a GJ tube via a surgically-created gastrostomy with >30 days follow-up (M/F: 24/20, median age: 28.0 months). The most common indication for GJ tube was reflux (n=21) and the most common clinical history was neurologic (n=28). Medical records and imaging were reviewed to identify complications and record weight-for-age Z scores based on CDC's 2000 Growth Charts. Complications were classified as minor or major according to SIR guidelines. Tube maintenance issues (TMIs) were separately recorded. Fixed effects analysis of repeated measures was performed to evaluate the change in average weight-for-age z-scores over time. Clinical follow-up information was also obtained.
Results
A total of 31,378 device days (median: 634 days) were observed. 3 patients (6.8%, 0.01/100 days) had aspiration pneumonia (major complication). 63 minor complications (0.20/100 days) were seen in 31 patients (70.5%) with vomiting the most frequent (n=18). 202 TMIs (0.64/100 days) occurred in 41 patients (93.2%) with dislodgement the most frequent (n=77). There was a significant increase in mean z-score at 6 month intervals relative to mean z-score of -3.22 at conversion: 0.81 at 1-6 months (p<.001), 1.28 at 7-12 months (p<.001), 1.22 at 13-18 months (p=.001), 1.16 at 19-24 months (p=.01), and 1.39 at 25+ months (p=.01). At last clinical follow-up, 32 patients were still using a GJ tube. The remaining 12 patients had conversion back to a G tube due to tolerating oral feeding (n=6), continued dislodgement (n=1), repeated migration into esophagus (n=1), intolerance to J tube feeding (n=2), and request by a guardian (n=2).
Conclusions
GJ tube placed via surgically-created gastrostomy in DD children with intolerance to G tube feeding was a viable option to help improve weight gain and could be a bridge to oral feeding. The frequent minor complications and TMIs were a drawback.