Nutrition for children with chronic diseases and syndromes
Judy More in Infant, Child and Adolescent Nutrition, 2021
If tube feeding continues to be necessary for a longer period of time (about 6 weeks or more), gastrostomy feeding may be used (Martínez-Costa et al. 2019). A gastrostomy is formed which requires a minor surgical procedure: a short tube is passed directly through the child’s skin and stomach wall and into the stomach. It is held in position with a plastic clamp or a button with a small inflatable balloon that sits inside the stomach. The feeding tube can then be connected directly to the gastrostomy device without having to go via the nose/mouth. When this form of feeding is no longer needed, the gastrostomy device can be removed and the small hole in the skin and stomach wall will close over and heal. A tiny scar may be the only indication that this route of feeding was ever used.
Gastrostomy
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
A similar approach involves tacking the stomach directly to the fascia. This is typically accomplished with trocars at the umbilicus and the chosen site for the gastrostomy (Figure 31.18a). A laparoscopic Babcock or similar grasper is placed into the trocar and a site along the greater curvature, away from the pylorus, is grasped and brought through the abdominal wall. A stay suture is placed to allow manipulation of the site. The stomach is then secured directly to the fascia in three or four locations (Figure 31.18b), with a purse-string suture placed circumferentially leaving adequate room for the gastrostomy (Figure 31.18c). A gastrostomy is then made, and the gastrostomy tube is placed directly into the stomach. We typically inflate the balloon under direct laparoscopic visualization in order to confirm intraluminal placement. The purse string is then secured around the gastrostomy, and the tube is flushed to ensure that there is no leak.
Minimally invasive neonatal surgery
Prem Puri in Newborn Surgery, 2017
Gastrostomy placement to provide total or supplemental nutrition is a common procedure in infants and children. In many centers, gastroenterologists (sometimes in close collaboration with the pediatric surgeons) perform most of these feeding tube placements using the percutaneous endoscopic gastrostomy tube. The procedure combines flexible esophageal gastroduodenoscopy with percutaneous puncture of the stomach to place a gastrostomy tube that can later be replaced by a gastrostomy button device. However, the percutaneous endoscopic technique has significant drawbacks and a relatively high complication rate, including bowel perforation.19 Therefore, we prefer the laparoscopic, single-incision technique for gastrostomy tube placement that has been developed in our center.20 This procedure allows visualization of the stomach and abdominal wall during the entire process, avoiding injury of adjacent viscera. It also permits primary placement of a gastrostomy button device, which is preferred by the caregivers.
Impact of choice of feeding tubes on long-term swallow function following chemoradiotherapy for oropharyngeal carcinoma
Published in Acta Oncologica, 2019
Robin J. D. Prestwich, Louise J. Murray, Gillian F. Williams, Emma Tease, Lucy Taylor, Cathryn George, Kate Cardale, Karen E. Dyker, Patrick Murray, Mehmet Sen, Satiavani Ramasamy
The data in the overall cohort demonstrated that patients managed with a prophylactic gastrostomy on average lose significantly less weight than patients managed with the NG as required approach; this is despite no significant difference in radiotherapy dose/delivery of cycles of concurrent chemotherapy. These observations are in line with prior series by ourselves [7] and others [10,12–14,17]. This finding did not reach significance in the subgroup offered a choice although the same magnitude of difference in percentage weight loss was observed. The reason for the reduced weight loss with a prophylactic gastrostomy is likely to be related to the observation that a significantly higher proportion of these patients receiving enteral feeding (92% vs. 58%, p < .001 and that median duration of feeding is significantly longer (median 3.3 vs. 1.2 months, p < .001). Overall patients with a gastrostomy already in situ are more likely to be prepared to commence enteral feeding support and to be prepared to continue enteral feeding for longer with a tube which is not visible to others. Related to this are observations from prior studies [13,16,17] that quality of life on completion of treatment is higher in patients managed with a gastrostomy.
Emerging drugs for the treatment of epidermolysis bullosa
Published in Expert Opinion on Emerging Drugs, 2020
Matthias Titeux, Mathilde Bonnet des Claustres, Araksya Izmiryan, Helene Ragot, Alain Hovnanian
Gastrointestinal tract complications are most commonly seen in RDEB but can also be present in EBS and JEB subtypes. They contribute to nutritional compromise. Painful dysphagia resulting from the acute blistering of the pharynx or esophagus is treated with systemic corticosteroids. Esophageal strictures are ideally treated by fluoroscopically guided balloon dilatation. However, recurrence of strictures after dilatation is frequent. Gastroesophageal reflux disease usually responds to Histamine 2 – blockers, proton pump inhibitors or pro-motility agents. Growth retardation is common and is thought to occur from insufficient oral intake, increased energy expenditure and malabsorption. Gastrostomy feeding may be necessary to maintain adequate nutrition. Constipation is frequent and alleviation requires adequate fluid and dietary fiber intake, mineral oil, lactulose, osmotic and stimulant laxatives. Pyloric atresia seen in EB with pyloric atresia (EB-PA) is treated by early surgical correction.
Why is nutrition vital for advancing ALS care and clinical research?
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2023
Edward J. Kasarskis, Rup Tandan
Now we get back to the very foundations of life ― nutrition, hydration and ventilation ― FFA if you will, for the management of ALS in the clinic and for human drug trials going forward. The implementation involves recursive measurement of body fat as an index of adequate energy intake (6), in addition to ALSFRS-R to indicate disease severity and progression (14), and %FVC/MIP/MEP as indices of ventilatory status (5). Based on recent research, we developed an app (ALSNutrCalc.ukhc.org) to facilitate the easy implementation of these nutritional principles for ALS management. The interventions are clear and incontrovertible: adequate daily nutrition and hydration via gastrostomy when these needs are unmet orally. By doing so, we will improve not only patient care but also the design of clinical drug trials. We cannot continue to do the same old thing and expect a different result (with all due respect to Albert Einstein’s wisdom).
Related Knowledge Centers
- Epigastrium
- Hypochondrium
- Laparotomy
- Stoma
- Percutaneous
- Interventional Radiology
- Percutaneous Endoscopic Gastrostomy
- Feeding Tube