Gastrostomy as a decompression technique in children with chronic gastrointestinal obstruction

Background: Percutaneous or surgical insertion of gastrostomy tubes for fee ding children has been well described. However, there is no report of percu taneous gastrostomy for chronic decompression in children with chronic gast rointestinal obstruction. The objective of this study was to evaluate this technique. Methods: Eighteen gastrostomies were performed for gastrointestinal decompr ession in children. The patients ranged in age from 2 to 125 months (median : 15.5). and all had prolonged hospital stays for severe disease: severe ga stroparesis and/or duodenal dysmotility (n = 8), duodenal stenosis (n = 2), chronic intestinal pseudo-obstruction (n = 4), enterocolitis (n = 2), and metastatic abdominal carcinomatosis (n = 2). The duration of symptoms befor e gastrostomy placement ranged from 0.5 to 44 months (median: 2), with majo r symptoms including epigastric pain, early satiety, nausea, vomiting, and bloating. Results: The goals of gastric decompression and removal of the nasogastric tube were achieved in all patients, and all had significant relief of both nausea and emesis. Oral intake of liquids and soft foods was possible in 17 of 18 of the children. The tubes were kept in place for a median of 22.5 m onths (range, 2-73). There was neither long-term morbidity nor mortality as sociated with the presence of the tube. Seventeen patients returned home wi th gastric decompression and cyclic parenteral nutrition, two of them for t erminal care. Six patients died. In all patients, gastrostomy was used thro ughout and did not contribute to the death of the patients. For seven child ren, tubes were removed because of resolution of small bowel or gastric out let obstruction. Conclusions: Gastrostomy is an efficient and well-tolerated method of achie ving long-term gastric decompression in children with abdominal obstruction not amenable to surgery and/ or resistant to medical treatment.