Is antegrade gastrostomy insertion in very low weight infants feasible?

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A study presented at the Society of Interventional Radiology’s (SIR’s) 39th Annual Scientific Meeting (San Diego, USA) by Sam Stuart from Great Ormond Street Hospital for Children, London, UK, suggests that antegrade gastrostomy insertion in infants who are less than 5kg in weight, is technically feasible and safe.

The results of the study showed that antegrade gastrostomy resulted in comparable technical success and complication rates to radiological or endoscopic gastrostomy insertion in larger children in the published literature.

 

Some endoscopists and surgeons have considered the lower limit of body weight to insert gastrostomies to be 10kg. However, but gastrostomies can be inserted safely into smaller children, Stuart noted.


The team set out to investigate the technical success and safety of a standardised radiological antegrade primary gastrostomy insertion technique in children weighing 5kg or less. They then carried out a retrospective analysis of all gastrostomies inserted at a single centre over a ten year period between 2003 and 2013 and identified 596 patients undergoing antegrade gastrostomy insertion. Of these, 25 patients weighing less than 5kg were identified.

The standardised technique for primary antegrade gastrostomy insertion included the use of a 9F Freka gastrostomy, general anaesthesia, biplane fluoroscopy and oral barium prior to the procedure to visualise the colon.

Stuart said that the mean age of the children weighing less than 5kg was six months, range (2–20m) and there were 20 male infants in the studied group.

“Patients weighed from 3–5kg (mean 4.5kg). Antegrade gastrostomy insertion was successful in 24/25 patients with no major complications. The unsuccessful procedure was a result of gross hepatomegaly preventing a safe route for access to the stomach despite distension with air. Three patients (13%) had minor complications; two exit site infections and one exit site leakage. All resolved without sequelae with conservative management. No deaths occurred within 30 days of procedure.

Stuart said: “The results are comparable to those in this centre for children weighing >5kg and those in the published literature for gastrostomy insertion in children of all weights and ages.

The same team also reported data that suggest that antegrade gastrostomy insertion using this technique in children has a high success rate and low rate of complications comparable to reports in the published literature for retrograde interventional radiology approaches as well as surgical and endoscopic techniques.

Stuart told Interventional News:“The results of this retrospective study suggest that an antegrade radiological approach to gastrostomy insertion in children is safe and can be performed in children weighing less than 5kg with a high rate of technical success. It concurs with the published literature and demonstrates that many methods of gastrostomy insertion both radiologically and endoscopically can be used effectively in children. This means the approach used can be tailored on a patient by patient basis.”