Öz
Purpose: Percutaneous endoscopic gastrostomy is the most preferred method for feeding in children with intact gastrointestinal system functions when oral nutrition is insufficient due to neurological, neuromuscular, or oncological diseases. This study aimed to evaluate the indications for percutaneous endoscopic gastrostomy and associated complications in the patients we followed up.
Materials and Methods: In this descriptive study, the records of 130 patients who underwent percutaneous endoscopic gastrostomy for nutritional support between January 1st 2013- December 30th 2020 were retrospectively reviewed. Demographic data, indications, complications, and follow-up periods of the patients were examined.
Results: Of the patients, 75 were male and 55 were female. The mean age of the patients was 48 months (min 1 month-max 211 months). The evaluation of the patients with percutaneous endoscopic gastrostomy in terms of diagnosis revealed that 95 patients required nutritional support due to neuromotor retardation associated with neurological disease, 19 patients due to central nervous system tumor, and 13 patients due to metabolic disease. Considering complications, the most frequent minor complication was leakage in 11of the 33 patients, while the most frequent major complication was colonic fistulation in 6 of the 9 patients. Two patients required open surgery in the early period due to intra abdominal leak.
Conclusion: Although enteral nutrition with a percutaneous endoscopic gastrostomy tube seems to be an appropriate and reliable method to meet the nutritional needs of pediatric patients who have normal digestive system functions but cannot be fed orally due to swallowing disorders, it is necessary to pay attention to its complications like any surgical procedure.
Anahtar Kelimeler
Child gastrostomy endoscopy nutrition percutaneous endoscopic gastrostomy
Kaynakça
- Balogh B, Kovascs T, Saxena AK. Complications in children with percutaneous endoscopic gastrostomy (PEG) placement. World J Pediatr. 2019;15:12-6.
- Homan M, Hauser B, Romano C, Tzivinikos C, Torroni F, Gottrand F et al. Percutaneous endoscopic gastrostomy in children: An update to the ESPGHAN position paper. J Pediatr Gastroenterol Nutr. 2021;73:415-26.
- Heuschkel RB, Gottrand F, Devarajan K, Poole H, Callan J, Dias JA et al. ESPGHAN position paper on management of percutaneous endoscopic gastrostomy in children and adolescents. J Pediatr Gastroenterol Nutr. 2015;60:131-41.
- Szlagatys-Sidorkiewicz A, Borkowska A, Popińska K, ToporowskaKowalska E, Grzybowska-Chlebowczyk U, Wernicka A et al. Complications of PEG are not related to age-the result of 10-year multicenter survey. Adv Med Sci. 2016;61:1–5.
- Romano C, van Wynckel M, Hulst J, Broekaert I, Bronsky J, Dall'Oglio L et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. J Pediatr Gastroenterol Nutr. 2017;65:242–64.
- Andrew MJ, Parr JR, Sullivan PB. Feeding difficulties in children with cerebral palsy. Arch Dis Child Educ Pract Ed. 2012;97:222–9.
- Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980;15:872–5.
- Ahmad FK, Younes D, Al Darwish MB, Aljubain MA, Dweik M, Alda'as Y. Safety and outcomes of percutaneous endoscopic gastrostomy tubes in children. Clin Nutr ESPEN. 2020;38:160-4.
- Fortunato JE, Cuffari C. Outcomes of percutaneous endoscopic gastrostomy in children. Curr Gastroenterol Rep. 2011;13:293-9.
- Di Leo G, Pascolo P, Hamadeh K, Trombetta A, Ghirardo S, Schleef J et al. Gastrostomy placement and management in children: A single-center experience. Nutrients. 2019;11:1555.
- Srinivasan R, Irvine T, Dalzell M. Indications for percutaneous endoscopic gastrostomy and procedure-related outcome. J Pediatr Gastroenterol Nutr. 2009;49:584-8.
- Gale R, Namestnic J, Singer P, Kagan I. Caloric requirements of patients with brain impairment and cerebral palsy who are dependent on chronic ventilation. JPEN J Parenter Enteral Nutr. 2017;41:1366-70.
- Kidder M, Phen C, Brown J, Kimsey K, Oshrine B, Ghazarian S et al. Effectiveness and complication rate of percutaneous endoscopic gastrostomy placement in pediatric oncology patients. Pediatr Gastroenterol Hepatol Nutr. 2021;24:546-54.
- Cantez MS, Gerenli N, Ertekin V, Durmaz Ö. Perkütan endoskopik gastrostomi deneyimi-104 olgunun demografik bulguları. Turk Pediatri Ars. 2013;48:210-4.
- Koca T, Sivrice AÇ, Dereci S, Duman L, Akçam M. Çocuklarda perkutan endoskopik gastrostomi: tek merkez deneyimi. Turk Pediatri Ars. 2015;50:211-6.
Öz
Amaç: Perkütan endoskopik gastrostomi, nörolojik, nöromüsküler veya onkolojik hastalıklar nedeniyle oral beslenmenin yetersiz kaldığı, gastrointestinal sistem fonksiyonları sağlam olan çocuklarda en çok tercih edilen beslenme yöntemidir. Bu çalışma, takip ettiğimiz hastalarda peruktan endoskopik gastrostomi endikasyonlarını ve ilişkili komplikasyonları değerlendirmeyi amaçladı
Gereç ve Yöntem: Tanımlayıcı tipte olan bu çalışmada, 1 Ocak 2013-31 Aralık 2020 tarihleri arasında beslenme desteği amacıyla peruktan endoskopik gastrostomi uygulanan 130 hastanın kayıtları retrospektif olarak incelendi. Hastaların demografik verileri, endikasyonları, komplikasyonları ve takip süreleri incelendi.
Bulgular: Hastaların 75’i erkek, 55’i kadındı. Hastaların yaş ortalaması 48 ay (en az 1 ay- en fazla 211 ay) idi. Perkütan endoskopik gastrostomi uygulanan hastaların tanı açısından değerlendirilmesinde nörolojik hastalığa bağlı nöromotor reterdasyon nedeniyle 95, santral sinir sistemi tümörü nedeniyle 19, metabolik hastalık nedeniyle 13 hastanın beslenme desteğine ihtiyaç duyduğu görüldü. Komplikasyonlara bakıldığında en sık 9 hastanın 6’sında kolonik fistül oldu. İki hasta erken dönemde karın içi kaçak nedeniyle açık cerrahiye ihtiyaç duydu.
Sonuç: Perkütan endoskopik gastrostomi tüpü ile entereal beslenme, sindirim sistemi fonksiyonları normal olan ancak yutma bozuklukları nedeniyle ağızdan beslenemeyen pediatrik hastaların beslenme ihtiyaçlarını karşılamak için uygun ve güvenilir bir yöntem gibi görünse de her cerrahi işlemde olduğu gibi cerrahi komplikasyonlarına dikkat etmek gereklidir.
Anahtar Kelimeler
Çocuk gastrostomi endoskopi nutrisyon peruktan endoskopik gastrostomi
Kaynakça
- Balogh B, Kovascs T, Saxena AK. Complications in children with percutaneous endoscopic gastrostomy (PEG) placement. World J Pediatr. 2019;15:12-6.
- Homan M, Hauser B, Romano C, Tzivinikos C, Torroni F, Gottrand F et al. Percutaneous endoscopic gastrostomy in children: An update to the ESPGHAN position paper. J Pediatr Gastroenterol Nutr. 2021;73:415-26.
- Heuschkel RB, Gottrand F, Devarajan K, Poole H, Callan J, Dias JA et al. ESPGHAN position paper on management of percutaneous endoscopic gastrostomy in children and adolescents. J Pediatr Gastroenterol Nutr. 2015;60:131-41.
- Szlagatys-Sidorkiewicz A, Borkowska A, Popińska K, ToporowskaKowalska E, Grzybowska-Chlebowczyk U, Wernicka A et al. Complications of PEG are not related to age-the result of 10-year multicenter survey. Adv Med Sci. 2016;61:1–5.
- Romano C, van Wynckel M, Hulst J, Broekaert I, Bronsky J, Dall'Oglio L et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. J Pediatr Gastroenterol Nutr. 2017;65:242–64.
- Andrew MJ, Parr JR, Sullivan PB. Feeding difficulties in children with cerebral palsy. Arch Dis Child Educ Pract Ed. 2012;97:222–9.
- Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980;15:872–5.
- Ahmad FK, Younes D, Al Darwish MB, Aljubain MA, Dweik M, Alda'as Y. Safety and outcomes of percutaneous endoscopic gastrostomy tubes in children. Clin Nutr ESPEN. 2020;38:160-4.
- Fortunato JE, Cuffari C. Outcomes of percutaneous endoscopic gastrostomy in children. Curr Gastroenterol Rep. 2011;13:293-9.
- Di Leo G, Pascolo P, Hamadeh K, Trombetta A, Ghirardo S, Schleef J et al. Gastrostomy placement and management in children: A single-center experience. Nutrients. 2019;11:1555.
- Srinivasan R, Irvine T, Dalzell M. Indications for percutaneous endoscopic gastrostomy and procedure-related outcome. J Pediatr Gastroenterol Nutr. 2009;49:584-8.
- Gale R, Namestnic J, Singer P, Kagan I. Caloric requirements of patients with brain impairment and cerebral palsy who are dependent on chronic ventilation. JPEN J Parenter Enteral Nutr. 2017;41:1366-70.
- Kidder M, Phen C, Brown J, Kimsey K, Oshrine B, Ghazarian S et al. Effectiveness and complication rate of percutaneous endoscopic gastrostomy placement in pediatric oncology patients. Pediatr Gastroenterol Hepatol Nutr. 2021;24:546-54.
- Cantez MS, Gerenli N, Ertekin V, Durmaz Ö. Perkütan endoskopik gastrostomi deneyimi-104 olgunun demografik bulguları. Turk Pediatri Ars. 2013;48:210-4.
- Koca T, Sivrice AÇ, Dereci S, Duman L, Akçam M. Çocuklarda perkutan endoskopik gastrostomi: tek merkez deneyimi. Turk Pediatri Ars. 2015;50:211-6.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma |
| Yazarlar | |
| Erken Görünüm Tarihi | 11 Temmuz 2023 |
| Yayımlanma Tarihi | 2 Temmuz 2023 |
| Kabul Tarihi | 27 Mart 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 48 Sayı: 2 |
