RETROGRADE PERCUTANEOUS GASTROSTOMY AND GASTROJEJUNOSTOMY IN 505 CHILDREN - A 4 1 2-YEAR EXPERIENCE/

PURPOSE To evaluate a technique of retrograde insertion of gastrostomy and gastrojejunostomy tubes with radiologic guidance in children. MAT ERIALS AND METHODS: During a 41/2-year period, 511 patients underwent attempted insertion of gastrostomy or gastrojejunostomy tubes. Patient s' ages ranged from premature to 18.6 years (mean age, 3.8 years), and weight range was 0.8-86.0 kg (mean weight, 12 kg). The charts of 453 patients were reviewed. RESULTS: Placement was unsuccessful in six pat ients because of colonic interposition (n = 2), microgastria (n = 2), or hepatosplenomegaly (n = 2). Initial placement was a gastrostomy tub e in 436 patients and a gastrojejunostomy tube in 69 patients. Sixty-e ight gastrostomy tubes were converted to gastrojejunostomy tubes. Earl y complications (<30 days) included skin infection (n = 11), stoma irr itation (n = 20), and tube dislodgment (n = 6). Late complications inc luded stoma irritation (n = 29), skin infection (n = 23), tube leakage (n = 14), and discomfort during feeding (n = 15). Two complications n ecessitated surgery: extragastric misplacement and small-bowel transgr ession. There were no tube-related deaths. CONCLUSION: Percutaneous re trograde placement of gastrostomy or gastrojejunostomy tubes safely an d effectively provides long-term nutrition for children. A team approa ch is essential to provide service to this cumulative population.