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PEDIATRICS Vol. 114 No. 2 August 2004, pp. 458-461

Complications Associated With Image-Guided Gastrostomy and Gastrojejunostomy Tubes in Children

Jeremy N. Friedman, MBChB, FRCPC*, Sabrina Ahmed, MD{ddagger}, Bairbre Connolly, MBChB, FRCPC§, Peter Chait, MBChB, FRCPC§ and Sanjay Mahant, MD, FRCPC*

* Division of Pediatric Medicine and Pediatric Outcomes Research Team, University of Toronto, Toronto, Ontario, Canada
{ddagger} Department of Family Medicine, McGill University, Montreal, Quebec, Canada
§ Department of Diagnostic Imaging, Hospital for Sick Children, and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada

Objective. To evaluate the complications associated with the image-guided insertion of gastrostomy (G) and gastrojejunostomy (GJ) tubes in children, performed by the retrograde percutaneous route.

Methods. A convenience sample of 208 charts of 840 patients recorded as having G and/or GJ tubes placed by the interventional radiology service in a 4-year period (1995–1999) at the Hospital for Sick Children in Toronto, Canada, were selected for review. Complications were categorized as major (including subcutaneous abscess, peritonitis, septicemia, gastrointestinal bleeding, and death) or minor.

Results. In total, 253 tubes (208 G tubes, 41 GJ tubes, 4 G and GJ tubes) were placed in the 208 patients reviewed. The median age at the time of insertion was 15 months (range: 7 days–18 years). The most common diagnostic category was neurologic disease (47%). The main indications for tube insertion were recorded as failure to thrive (57%) and risk of aspiration (47%). Major complications were seen in 5% of patients. Peritonitis was noted in 3%, and there was 1 death related to tube insertion (0.4%). Minor complications were found in 73% of patients, including tube dislodgement (37%), tube leakage (25%), and G-tube site skin infection (25%). GJ tubes had a higher rate than G tubes of obstruction, migration, dislodgement, leakage, and intussusception. Site infection, gastroesophageal reflux, and bleeding from the site were seen less frequently in patients with GJ tubes compared with G tubes.

Conclusion. G and GJ tubes placed by the image-guided retrograde percutaneous method are associated with a wide range of complications. The majority of these are minor and are predominantly related to tube maintenance, but major complications, including death, do occur.

Key Words: gastrostomy tube • gastrojejunostomy tube • image-guided • complications

Abbreviations: G tube, gastrostomy tube • GJ tube, gastrojejunostomy tube • PEG, percutaneous endoscopic gastrostomy • GER, gastroesophageal reflux

Received for publication Aug 12, 2003; Accepted Dec 29, 2003.


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