Advances and challenges of gastrostomy insertion in children

Abstract

When oral feeding cannot provide adequate nutritional support to children, enteral tube feeding becomes a necessity. The overall aim is to ultimately promote appropriate growth, improve the patient’s quality of life and increase carer satisfaction. Nasogastric tube feeding is considered appropriate on a short-term basis. Alternatively, gastrostomy feeding offers a more convenient and safer feeding option especially as it does not require frequent replacements, and carries a lower risk of complications. Gastrostomy tube feeding should be considered when nasogastric tube feeding is required for more than 2-3 wk as per the ESPEN guidelines on artificial enteral nutrition. Several techniques can be used to insert gastrostomies in children including endoscopic, image guided and surgical gastrostomy insertion whether open or laparoscopic. Each technique has its own advantages and disadvantages. The timing of gastrostomy insertion, device choice and method of insertion is dependent on the local expertise, patient requirements and family preference, and should be individualized with a multidisciplinary team approach. We aim to review gastrostomy insertion in children including indications, contraindications, history of gastrostomy, insertion techniques and complications.

Keywords: Laparoscopic gastrostomy; Percutaneous endoscopic gastrostomy; Laparoscopic-assisted gastrostomy; Laparoscopic-assisted percutaneous endoscopic gastrostomy; Radiologic gastrostomy; Open gastrostomy

Core Tip: Gastrostomy tubes are inserted to support the long-term nutritional needs of children when oral feeding becomes compromised. Gastrostomy insertion has evolved over the last century to involve multiple feeding devices and various insertion techniques. The insertion technique and device choice need to be selected after careful consideration of patient background medical history, patient needs, available facilities and after adequate counseling in a multi-disciplinary team setting. In this review we will present the indications, contraindications, history, advances, insertion techniques, challenges and complications of gastrostomy insertion in children.