Systematic review of gastrostomy complications and outcomes in pediatric cancer and bone marrow transplant

Nutrition support is essential in children with cancer, including those undergoing bone marrow transplant (BMT), to reduce the risk of malnutrition and associated deleterious outcomes. Enteral nutrition is more commonly provided via nasogastric than gastrostomy tubes due to safety concerns with the latter in immunocompromised children. This systematic review investigated the incidence and type of complications and outcomes in pediatric cancer patients fed by gastrostomy. Across studies, 54.6% of children developed ≥1 complication, of which 76.6% were classified as minor, 23.4% major. The most frequent complications included inflammation (52% of episodes), infection (42.1%), leakage (22.3%) and granuloma (21%). Evidence regarding infection rates in cancer/BMT patients compared with other disease states was inconclusive. Gastrostomy feeding was associated with improvement or stabilization of nutritional status in 77-92.7% of children. Gastrostomy feeding in this population is safe and effective in stabilizing or improving nutritional status throughout treatment. Complications are frequent but mostly minor.

General principles for the prevention and treatment of complications of percutaneous endoscopic gastrostomy (review of literature)

We considered the views of researchers presented in the modern literature on both the problem as a whole and discussion questions regarding the causes of development, preventive measures, and methods of treating percutaneous endoscopic gastrostomy complications, such as clogging of the gastrostomy tube, peristomal wound infections, necrotic fasciitis, pneumoperitoneum, buried bumper syndrome, growth of granulations in the gastrostomy zone, postoperative bleeding and intraparietal hematoma of the gastric wall, traumatic dislocation of the gastrostomy tube, peritonitis after percutaneous endoscopic gastrostomy, peristomal leakage, сolonic fistula, liver injury and abdominal wall metastasis at the percutaneous endoscopic gastrostomy site.

Laparoscopic Gastrostomy Placement in Children Has Few Major, but Many Minor Early Complications

Introduction Laparoscopic gastrostomy (LAPG) is an increasingly popular alternative to more traditional gastrostomy techniques. This study evaluates early postoperative complications following LAPG and investigates risk factors for gastrostomy complications. Materials and Methods Retrospective study of patients <16 years undergoing LAPG from 2005 to 2018. Early postoperative complications (<30 days) were grouped as gastrostomy-related or general and graded according to the Clavien-Dindo classification for surgical complications. Results A total of 104 patients, of which 54 (52%) had neurological impairment (NI), were included. Median age and weight were 1.2 years (1 day–15.2 years) and 8.9 kg (3.4–36), respectively. Operating time was median 37 minutes (19–86) and shorter in the second half of the patients (46 vs. 35 minutes, p = 0.04). A total of 40 (38%) patients experienced 53 gastrostomy-related complications. Of these, seven complications needed surgical treatment; severe leakage (2), too short gastrostomy button (1), feeding difficulties (1), gastric outlet obstruction (1), omentum trapped in umbilical port sutures (1), and suspected fascial defect (1). Stoma infection and granulation tissue were reported in 13 and 12%, respectively. Tube dislodgement occurred in six patients and was managed with bedside reinsertion in all. Gastrostomy-related complications were less frequent in NI patients (46 vs 22%, p = 0.01). Conclusion LAPG is a safe procedure with few major complications, but a high rate of minor complications. Operating time declined during the study period, and NI patients had fewer gastrostomy-related complications.