Cyclosporine for active crohn's colitis in children

Journal of vascular and interventional radiology : JVIR, 2014

Paediatrics & child health, 2011

Gastrostomy (G) and gastrojejunostomy (GJ) tubes are commonly used to enhance nutrition and hydration, and facilitate the administration of medications to children with medically complex conditions. They are considered to be safe and effective interventions for the medical management of these patients; however, they are not without risks. There are common complications associated with G and GJ tubes. Health care providers play an active role in preventing, managing and supporting the patient and parents/caregivers in dealing with these complications. The present article reviews G and GJ tube devices, basic care principles, and how to prevent and manage common complications. Recommendations for how to support and share information with parents/caregivers is provided.

Medicina, 2021

Background and Objectives: When the human body is disabled to naturally ingest food through the mouth, enteral or parenteral nutritional support should be started. Percutaneous gastrostomy (PEG) is a flexible feeding tube that is inserted into the stomach through the abdominal wall in patients who will need long-term enteral nutrient intake. The aim of this study is to analyze clinical characteristic of children at the time of PEG placement as well as to determine indications, complications and outcomes associated with PEG at the Department of Pediatrics of the University Hospital of Split. Materials and Methods: Retrospective analysis of the medical records of patients treated from 2010 to 2020 was performed. The following data were collected from medical records: age, gender, information about nasogastric feeding before PEG placement, indication for PEG insertion, duration of PEG, procedure-related complications and treatment outcomes. Malnutrition was determined according to the ...

International Journal of Pediatrics

Background and Objective. Gastrostomy tube insertion is one of the most common procedures performed as a radical choice to overcome feeding difficulty in children. This study is aimed at describing the replacement of a button tube instead of the long tube for feeding infants and children requiring gastrostomies in a tertiary care hospital. Design and Setting. This retrospective cross-sectional descriptive study was conducted between January 2009 and August 2019 at Salmaniya Medical Complex which is a tertiary health care institute in the Kingdom of Bahrain. Subjects and Methods. Both charts and electronic health records of pediatric patients between the ages of 0 and 14 years were reviewed. Data were collected including age, sex, nationality, diagnosis, surgical information (procedure center and procedure performed), complications, and follow-up. Results. Out of 34 patients who underwent gastrostomy tube insertion, 30 patients had their long tube replaced by a button gastrostomy. Ma...

Journal of Pediatric Research, 2021

The aim of this study was to investigate the complications of percutaneous endoscopic gastrostomy in children. Materials and Methods: Ninety-one pediatric patients treated with percutaneous endoscopic gastrostomy (PEG) insertion by pull technique in a five-year period were enrolled into this study. Their hospital records were reviewed retrospectively for their demographic data, their primary diseases causing nutritional insufficiency, and any major or minor complications after PEG insertion. Results: The 91 patients who were included in this study were aged between 1 month and 18 years (median 79 months). 45.1% (n=41) of the patients were female. The majority of the patients (76.9%, n=70) had neurological diseases. Nineteen patients (20.9%) had metabolic diseases and two patients had cystic fibrosis (2.2%). We observed 37 (40.7%) complications in total. Three (3.3%) of them were major and 34 (37.4%) of them were minor complications. Conclusion: Endoscopic percutaneous gastrostomy placement is an important way to continue enteral feeding in children. Although PEG is a minimally invasive technique, there are some problems which may be experienced by the children and their parents after PEG insertion, the majority of the these being minor complications.

Journal of Laparoendoscopic …, 2010

Gastrostomy tube placements in children are associated with frequent postoperative complications. Children with gastrostomy tubes are frequent visitors to the emergency department and outpatient clinic. The aim of this study was to determine the incidence of postoperative gastrostomy complications and disclose if these were correlated to the patients' age and diagnosis. This is a prospective study of children who had undergone laparoscopic gastrostomy tube placement from June 2006 through March 2011. Patient demographics, comorbidities, and complications were collected. Data were analyzed by Fisher's exact test. P<0.05 is considered significant. One hundred and sixty-two children were evaluated, with the majority of patients <2 years of age (106/162). All the patients had undergone laparoscopic-assisted gastrostomy with double U-stitch technique. Granulation tissue, vomiting, infection, leakage were the most common postoperative complications. The majority of patients with these complications had full resolution by the sixth postoperative month. Tube dislodgement was a complication, occurring 16 times in 14 of the patients (10%) and resulting in 16 emergency department (ED) visits. Diagnoses were predictive of complications, and age and gender were not. Granulation tissue, vomiting, infection, leakage and tube dislodgement are complications after gastrostomy placement in children. The age of the child, was not predictive of complications but children with congenital cardiac malformation and malignant diseases had more frequent postoperative complications. Ethical considerations Intention to treat was the main analysis strategy and encompassed all the patients.

Acta gastro-enterologica Belgica

Monocentric retrospective paediatric study describing indications for gastrostomy and major complications, compared to literature data as part of a quality check. Records of all gastrostomy patients consulting at the UZ Ghent paediatric gastro-enterology department between January 2007-December 2009 were reviewed in December 2010 regarding indication, age and weight at tube insertion, insertion method, major complications and current gastrostomy tube type. 178 patients were included of which 165 (93%) were placed using the endoscopic pull technique, the others were placed surgically (n = 13). Neurodevelopmental disability with oral motor dysfunction was the major indication (113, 63%). Other indications were failure to thrive due to concomitant disease (65, 37%). Median age at tube insertion was 3yr (interquartile range (IQR) 0.6-9) with median tube time of 3.9 yr (IQR 1.9-7.2). Immediate complications were 1 peritonitis and 1 post-insertion fever episode. Late complications (10, 5....

Journal of Pediatric Gastroenterology &amp; Nutrition, 2019

This study retrospectively evaluated the safety, impact on growth, and clinical outcomes of gastrojejunostomy tubes (GJTs) converted from surgically placed gastrostomy tubes (GTs) in 44 developmentally disabled children (median age: 28 months). The total duration of GJT follow-up was 31,378 device-days (median: 643 device-days). Three major complications (aspiration pneumonia) were identified in 3 patients (6.8%), 63 minor complications in 31 patients (70.5%), and 202 tube maintenance issues (TMIs) in 41 patients (93.2%). A significantly increased average change in weight-forage z-scores was observed at each 6-month interval that continued past 25 months. Patients above the median rate of TMIs had marginally significant lower z-scores across the study period (P ¼ 0.06), compared with those below the median rate. GJTs were removed in 6 patients (13.6%) because of adequate oral intake at last follow-up. Conversion from GTs to GJTs was a viable option to achieve sustained growth in developmentally disabled children. Frequency of TMIs may negatively impact their growth.

Pediatric Radiology, 2001

Objective. To evaluate a newly developed method combining antegrade and retrograde techniques for percutaneous gastrostomy tube (PGT) insertion in the neonate and young infant. Materials and methods. From January 1994 to December 2000, 85 children (47 male, 38 female), mean age 4.5 months (range 0.44±9.13 months) underwent PGT insertion using the ªpush-pullº technique. With the addition, 57 children had a jejunostomy tube placed as well at or within 24 h of the PGT procedure. The mean weight was 3.74 kg, range 1.5±7.0 kg. The indications for the procedure included failure to thrive in 40 patients (25 %), static encephalopathy in 21 (25 %), neurological/congenital abnormalities in 12 (14 %), aspiration in 7 (8 %), and cardiac problems in 5 (6 %). Results. Eighty-five PGTs were successfully inserted in 85 children. One procedure was initially unsuc

Journal of Laparoendoscopic & Advanced Surgical Techniques, 2013

Background: Placement of a primary gastrojejunal tube (GJT) can be technically challenging and often requires an open procedure to negotiate the tube past the duodenal sweep into the jejunum. The alternative approach is to first place a gastrostomy tube (GT), which is then changed to a GJT under endoscopic or fluoroscopic guidance after waiting 6-8 weeks to allow the stoma to mature. We report a case series of primary GJT placement using a combined laparoscopic-endoscopic approach. Subjects and Methods: We retrospectively reviewed patients who underwent a combined laparoscopicendoscopic primary GJT placement. Patients' demographics and relevant clinical information were analyzed. Results: Six patients (4 male, 2 female) were identified. The median age at the time of operation was 30.2 months (range, 28 days-10 years). Five GJTs were successfully placed laparoscopically/endoscopically, and one procedure was converted to open. The mean operative time was 84 minutes (range, 63-102 minutes). Postoperative abdominal radiography confirmed post-pyloric tube position in all patients. Feedings were initiated on the first postoperative day. One intraoperative complication required conversion to an open procedure. No patients developed postoperative complications. Conclusions: Laparoscopic-endoscopic primary GJT placement is technically feasible and an excellent alternative in patients who require transpyloric feeding access.