Upper Gastrointestinal Access in Children: Techniques and Outcomes

The Hospital for Sick Children, Toronto, Ontario, Canada.
Techniques in vascular and interventional radiology 12/2010; 13(4):222-8. DOI: 10.1053/j.tvir.2010.04.004
Source: PubMed


This article describes the radiologic techniques to obtain upper gastrointestinal access in children with poor oral intake and inadequate nutrition. Our goal is to provide a simple guide of radiologic gastrostomy and gastrojejunostomy procedures, their technical success, and long-term outcomes. Potential complications will be discussed as well as their management. It is important to emphasize that a multidisciplinary approach (pediatrician, dietitian, interventional radiologist, pediatric surgeon) is paramount for appropriate indications and management of patients with gastrostomies and gastrojejunostomies.

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    • "These issues may result in the need for additional surgery [7]. The radiologic option is a percutaneous gastrojejunostomy (GJ) [8]. This option is less invasive, requires less recovery time, and can be removed if symptoms of gastroesophageal reflux improve. "
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    ABSTRACT: Children with neurologic impairment often fail medical management of gastroesophageal reflux and proceed to fundoplication and gastrostomy (FG) or percutaneous gastrojejunostomy (GJ). Current guidelines do not recommend one treatment over the other, and there is ongoing uncertainty regarding clinical management. We conducted a structured search of Medline, Embase, trial registries, and the gray literature. We included studies that compared outcomes for FG and GJ in children with neurologic impairment. We identified 556 children from three retrospective studies who underwent FG (n=431) or GJ (n=125). There were no differences in rates of pneumonia (17% vs 19%, p=0.74) or mortality (13% vs 14%, p=0.76). Few deaths were due to procedural complications (1%) or reflux (2%). There was a trend towards more major complications with FG (29%) compared to GJ (12%) (risk ratio=1.70, 0.85-3.41, p=0.14). Minor complications were more common with GJ (70%) than FG (45%), but this difference was also not statistically significant (risk ratio=0.38, 0.05-3.07, p=0.36). No studies reported quality of life using validated measures. The quality of the evidence for outcomes of FG versus GJ is very low. Large comparative studies are needed to determine which approach is associated with the best quality-of-life outcomes. Copyright © 2015. Published by Elsevier Inc.
    Journal of Pediatric Surgery 02/2015; 50(5). DOI:10.1016/j.jpedsurg.2015.02.020 · 1.39 Impact Factor
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    ABSTRACT: Magnetic compression anastomosis is used for gastrointestinal, biliary, and urinary anastomoses. We have developed a simple magnetic compression gastrostomy technique in rats. Animals were randomized into two groups (n = 12 each): magnetic gastrostomy (MG) and surgical gastrostomy (SG) (control). In the MG group, a magnetic insertion catheter was coupled with the first magnetic ball and introduced transorally into the stomach. A second magnetic ball was placed subcutaneously into the left upper quadrant. The two magnetic balls (4 mm) were strongly coupled together. On postoperative day (PD) 20 (MG group) and PD10 (SG group), rats were killed, gastrostomies were evaluated macroscopically and histopathologically, and mechanical burst testing was performed. Two animals died due to suspected leaks. Macroscopic evaluation indicated no gastrostomy canal in one rat in each group. Mild adhesion was observed in two rats in the MG group. Moderate adhesion was observed in all rats in the SG group. No significant differences were observed in burst pressure between the two groups (means: MG group, 143 mmHg, n = 9; SG group, 159 mmHg, n = 8). Magnetic compression gastrostomy can be performed easily in rats, and may be developed in future as a simple alternative to some gastrostomy procedures in humans.
    Pediatric Surgery International 01/2012; 28(5):529-32. DOI:10.1007/s00383-012-3053-2 · 1.00 Impact Factor
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    ABSTRACT: Interventional radiology procedures are increasingly in demand in both the adult and pediatric populations. Pediatric procedures mirror many of the adult procedures but with increased complexity due to considerations related to patient size and the requirements for sedation and radiation protection. This article reviews the various nonvascular pediatric interventional procedures and provides information on sedation and radiation protection. The aim is to provide a greater exposure to the possible treatment options for pediatric patients and to facilitate understanding of imaging after various interventions.
    Canadian Association of Radiologists Journal 01/2012; 63(3 Suppl):S49-58. DOI:10.1016/j.carj.2011.08.003 · 0.52 Impact Factor
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