Mistakes in gastrostomy insertion in children and adolescents and how to avoid them

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Mistakes in gastrostomy insertion in children and adolescents and how to avoid them

Christos Tzivinikos, Ilse Broekaert, Jorge Amil Dias, Matjaz Homan

Summary

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This article addresses percutaneous endoscopic gastrostomy tube placement in children, combining evidence-based data with clinical experience to supplement existing guidelines.

PEG placement provides enteral feeding through the stomach with the same underlying principle in adults and children, but indications, considerations and techniques differ owing to anatomical differences, age-dependent physiological concerns, and age- and disease-specific needs
PEG or PEG-J tube placement should be considered when feeding via nasogastric tube or naso-jejunal tube is necessary for a prolonged time
PEG tubes allow delivery of medications and venting of the stomach when needed
Nutrition via PEG facilitates transition to out-of-hospital care and improves quality of life for children and families while improving outcomes in children with chronic diseases
Recent clinical guidelines provide guidance for PEG tube placement in children but offer little advice on device selection, postoperative management, tube removal and other specific cases

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Adequate nutrition is essential for the homeostasis of fluids and nutrients, growth and thriving, especially in children. While the underlying principle of percutaneous endoscopic gastrostomy (PEG) placement is the same for both adults and children—providing a means of enteral feeding through the stomach—the indications, considerations and techniques differ owing to anatomical differences, age-dependent physiological concerns, and the age- and disease-specific needs of the child.

If feeding via nasogastric tube (NGT) or naso-jejunal tube (NJT) is necessary for a prolonged time, placement of a PEG or percutaneous endoscopic gastro-jejunal (PEG-J) tube should be considered. A PEG tube also allows the delivery of medications and venting of the stomach when needed. Nutrition via PEG facilitates the transition to out-of-hospital care and improves the quality of life (QoL) for children and families while improving the outcome of children with chronic diseases.

There are recent clinical guidelines providing guidance for PEG tube placement in children, but little advice on, e.g., choosing the right device for the right patient, details on postoperative management, removal of the PEG tube and other specific cases. The following article provides a combination of evidence-based data and the authors’ clinical experience.

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Paediatrics Small Intestine & Nutrition Stomach & H. Pylori

Citation

Broekaert I.J, Dias J.A, Homan M and Tzivinikos C. Mistakes in gastrostomy insertion in children and adolescents and how to avoid them. UEG Education 2024; 24: 34-38.

Published

2024

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Mistakes in the evaluation and management of dysphagia and how to avoid them

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Dysphagia is a common symptom with a broad differential diagnosis encompassing structural, inflammatory, infectious, functional, neurological, and oesophageal motility disorders. Despite major advances in endoscopy, high-resolution manometry (HRM), impedance planimetry (EndoFLIP), and swallowing assessment, diagnostic delays and inappropriate management remain common. In most cases, these shortcomings reflect errors in clinical reasoning rather than limitations of available investigations.¹

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Mistakes in abdominal distension and how to avoid them

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Abdominal distension and bloating are among the most frequently misunderstood complaints in gastroenterology. They are often used as interchangeable terms, a conceptual mistake that continues to drive diagnostic errors and ineffective treatment. According to Rome IV, bloating and distension may represent either a primary disorder of gut–brain interaction (DGBI) or occur as symptoms with other DGBIs, such as irritable bowel syndrome (IBS), functional dyspepsia (FD) or functional constipation (FC).

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