Article

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

ABSTRACT 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.

0 Bookmarks
 · 
77 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: A ferromagnetic T-fastener is often used in children during gastrostomy procedures. We describe the experience with the use of a new gastropexy device (two parallel needles with a snare) that uses a non-ferromagnetic anchor during primary percutaneous retrograde radiologic gastrostomy insertion in four children with a mean age of 6 years and 6 months (range: 2 years and 11 months to 9 years and 6 months). The new gastropexy device was safe and effective in children. It is advantageous for children requiring magnetic resonance (MR) examinations soon after gastrostomy insertion, especially in view of MR-related implications that result from the use of a ferromagnetic T-fastener.
    Pediatric Radiology 08/2013; · 1.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Radiologic insertion of a gastrostomy or gastrojejunostomy tube is a common procedure in children. Glucagon is used to create gastric hypotonia, permitting gastric distension and facilitating percutaneous puncture. Glucagon can cause hyperglycaemia and potentially rebound hypoglycaemia. The safety of glucagon and incidence of hypoglycaemia has not been studied following gastrostomy or gastrojejunostomy tube insertion. To determine variations in blood glucose in children post gastrostomy or gastrojejunostomy tube insertion. Secondarily, to determine the frequency of hypoglycaemia and hyperglycaemia in children who did or did not receive glucagon. This is a retrospective observational study of 210 children undergoing percutaneous gastrostomy or gastrojejunostomy tube insertion over a 2-year period. We studied the children's clinical and laboratory parameters. Abnormal blood glucose levels were defined according to age-established norms. We used descriptive statistics and ANOVA. We analysed 210 children with recorded blood glucose levels. More than 50% of the children were less than the third percentile for weight. In the glucagon group (n = 187) hyperglycaemia occurred in 82.3% and hypoglycaemia in 2.7% (n = 5). In the no glucagon group (n = 23), hyperglycaemia occurred in 43.5% and there were no cases of hypoglycaemia. The peak blood glucose occurred within 2 h, with normalization by 6 h post-procedure. Five children became hypoglycaemic, all received glucagon; 4/5 had weights <3rd percentile. Logistic regression analysis revealed no factors significantly associated with hypoglycaemia. Greatest blood glucose variability occurs between 1 h and 3 h post-procedure. Hyperglycaemia is common and more severe with glucagon, and hypoglycaemia rarely occurs. These findings have assisted in developing clinical guidelines for post-percutaneous gastrostomy/gastrojejunostomy tube insertion.
    Pediatric Radiology 02/2014; · 1.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Retrograde radiologic gastrostomy is one of several techniques used for placing a gastrostomy and is a common technique used in children. The use of a retention anchor suture (RAS) is an important component of this procedure. This pictorial essay explores the normal course and passage of the RAS, as well as abnormal migration, various complications and the implications of the RAS with regard to MRI safety.
    Pediatric Radiology 02/2013; · 1.57 Impact Factor