Two recent studies highlight the risks with gastrostomy tube (G-tube) placement.
- McSweeney ME, et al. J Pediatr 2015; 166: 1514-9.
- Jacob A, et al. J Pediatr 2015; 166: 1526-8.
The first study, a chart review of 591 patients, identified a 10.5% major complication rate and ~25% complication rate overall. By far the most common complication for both major and minor complications was stoma infections. In this study, the g-tube used was the Corflo PEG tubes using a pull-procedure. Perioperative antibiotics (i.e. cefazolin for 24 hrs) were administered. Exchange of g-tubes (to a skin-level device) took place at 6 months in most patients. Major complications were defined as an unplanned adverse event necessitating additional hospitalization, surgery or interventional procedure.
- Cumulative incidence of major complications was 2.4% within 48 hours, 5.8% with 1 month, 9.2% within 6 months, and 14.7% at 12 months post-G-tube placement
- Among the 62 patients experiencing major complications, 55 of the 72 were due to infections, 6 were dehiscence of PEG at exchange, 2 were due to granulation needing surgery, 2 were due to colon perforation, and 1 due to pneumoperitoneum. Other major complications included: 1 aborted PEG procedure, 1 post-PEG cardiopulmonary arrest, 3 malfunctioning PEG tubes, and 1 failure to exchange PEG tube for a skin-level device.
Overall, this study shows a fairly high rate of significant complications and that their occurrence was usually not in the immediate post-operative period.
The second study was a prospective study of 183 children undergoing a one-step percutaneous G-tube using the MIC-KEY introducer kit. This one-step button requires insertion of three gastropexy anchors, dilatation of gastrostomy tract, and button measurement. The authors evaluated the safety technique and the learning curve.
- In the first 6-month period, the authors noted a 17% failure rate; this declined to 0-7% in the following 6-month study periods.
- The time for placement improved from 21 minutes during the first 6-months to 12 minutes during the sixth 6-month study period
- The authors highlighted several advantages: 1. lower peristomal infection rate (10.6% compared to their historical control of 29% with pull-PEG); the PEG avoids need to bypass the oropharynx. 2. One procedure/anesthetic for a skin-level device.
- In the article, the results indicate that there are clearly tradeoffs for these advantages: after the initial learning curve, their remained complications in the majority (65%), mostly mild complications which included accidental button removal (35%), gastric heterotopy (24%), and peristomal leakage (15%). Also, 35% of patients returned for a replacement tube before the planned date because of intragastric balloon deflation.
- The cost savings with this one-step button were estimated to be 11% lower.
Bottomline: While g-tubes remain important in caring for children with feeding problems, there is not a magic bullet to eliminate complications. Understanding the frequency of these problems and discussing them with families will help them be addressed promptly.
Related blog posts:
www.feedingtubeawareness.com This site contains a terrific PDF download which explains enteral tubes in an easy to understand style along with good graphics. “What You Need to Know Now, A Parent’s Introduction to Tube Feeding is the guidebook that every parent wished they had when they were first introduced to feeding tubes.”