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.
Stomach and duodenum
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
This is a longitudinal tear at the gastro-oesophageal junction, which is induced by repetitive and strenuous vomiting. Doubtless, many such lesions occur and do not cause bleeding. When it is a cause of haematemesis, the lesion may often be missed as it can be difficult to see as it is just below the gastro-oesophageal junction, a position that can be difficult for the inexperienced endoscopist. Occasionally these lesions continue to bleed and require surgical treatment. Often the situation arises in which the surgeon does not have guidance from the endoscopists as regards the site of bleeding, and a high index of suspicion in such circumstances is important. The experienced surgeon will perform on-table endoscopy prior to embarking on surgery. The stomach is opened by longitudinal gastrotomy and the upper section is carefully inspected. It is normally possible to palpate the longitudinal mucosal tear with a little induration at the edges, which gives a clue to the lesion's location. Under-running is all that is required.
Effects of treatment on the abdomen and pelvis
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
A gastrostomy tube is inserted into the stomach using endoscopic (PEG) or radiological guidance (RIG, PIG) in patients with dysphagia to improve nutrition or in patients with distal obstruction as a venting mechanism for symptomatic relief (41). A small amount of free gas is a normal finding in the few days following insertion; however, large volumes of free gas should prompt further investigation with CT or contrast injection under fluoroscopic guidance. Complications include traversing liver, small or large bowel, a loose gastrostomy tube, extragastric placement, anterior abdominal wall infection with abscess formation, and permanent gastrocutaneous fistula following removal. If a patient is unwell or complains of pain on feeding, feeding should be stopped and only recommenced after correct siting of the tube has been confirmed by imaging.
How people living with motor neurone disease and their carers experience healthcare decision making: a qualitative exploration
Published in Disability and Rehabilitation, 2022
C. Paynter, S. Mathers, H. Gregory, A. P. Vogel, M. Cruice
All participants were asked if they had considered a feeding tube. Participants experiencing dysphagia and/or weight loss reported the decision to proceed with PEG was straightforward; “[Name] was losing weight. So it was clear it was going to be an issue and do it sooner rather than later…It wasn’t anything that we needed to think about” (C06). One participant accepted a gastrostomy despite not wanting “invasive tubes” drawing a distinction between a feeding tube and a breathing tube despite the percutaneous insertion of both interventions. For participants asymptomatic for dysphagia, planning for gastrostomy was more complex and varied. The context being that the specialist MND clinic offers patients with deteriorating respiratory function early PEG placement. This allows for insertion under sedation. Later in the disease, gastrostomy insertion may be less safe, performed with less sedation or may no longer be possible. Participants without dysphagia symptoms often waited until disease progression forced a decision, or else relied heavily on healthcare professionals to guide that decision; “[The clinical team] are all saying well, you should have it [PEG] done while you can. So I went with their advice” (P12). One participant declined PEG.
Treatment of two newborns with esophageal atresia and distal tracheoesophageal fistula complicated by gastric perforation: choosing the simple way
Published in Acta Chirurgica Belgica, 2020
Mustafa Okumuş, Adil Umut Zübarioğlu, Reşit Atalan
Gastrostomy was not considered as an initial procedure because it might be more invasive and also time-consuming. A simple Penrose drain was not used for peritoneal drainage because it should not be bent and/or collapsed. For the improvement of respiratory functions, the air in the abdominal cavity should flow out continuously without any blockage, and for that purpose, the midline would be a better drainage site. The drain, which was adapted from a 12F aspiration catheter, was placed at the bedside. The tip of the drain was left open. Although there is a theoretical risk that a gastrostomy or a peritoneal drain in the infant with lung disease may create a low-pressure broncho-cutaneous fistula which makes effective ventilation even more difficult [13], our patients did well. The patients with gastrostomy are much more likely to develop bronco-cutaneous fistula because there is no resistance to air escape from the fistula. On the other hand, in patients with peritoneal drainage, the air must first pass through the gastrointestinal tract and fill the peritoneal cavity through the perforation site after reaching a certain pressure. We think that this mechanism may have reduced the air escape from the fistula.
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.
Related Knowledge Centers
- Epigastrium
- Hypochondrium
- Laparotomy
- Stoma
- Percutaneous
- Interventional Radiology
- Percutaneous Endoscopic Gastrostomy
- Feeding Tube