Highlights
- •What patients are at highest risk of complications from GT dislodgement?
- •Postoperative patients and those who require stoma dilation are more likely to have complications during emergent replacement.
- •What is the best way to confirm proper GT placement?
- •Contrast injection is the current standard of care.
- •Ultrasound is both a safe and highly specific confirmatory test when used to confirm gastrostomy placement.
Abstract
Background
Gastrostomy tube (GT) dislodgement is a common cause of Pediatric Emergency Department
(PED) visits. Postoperative patients and those who require stoma dilation are more
likely to have complications during emergent replacement. Although incorrect replacement
can cause significant morbidity overall, the occurrence is infrequent. Contrast injection
of the GT is considered the standard for confirming proper placement. Case reports
in both pediatric and adult patients suggest that ultrasound can be used to confirm
proper replacement. The objective of the present study was to assess the utility of
ultrasound to confirm GT placement in pediatric patients most at risk for complications
from incorrect replacement.
Methods
This is a non-randomized cohort pilot trial to determine the sensitivity and specificity
of ultrasound to confirm proper replacement of a GT in a Pediatric Emergency Department.
Results
We enrolled 55 pediatric subjects, of which 50 had ultrasound imaging after GT replacement
in the PED prior to contrast injection. Ultrasound was found to have 96% sensitivity
and 100% specificity for confirming GT placement.
Conclusions
Ultrasound is a safe and reliable confirmatory study to confirm GT placement in pediatric
patients, especially those at highest risk of complications from incorrect placement.
Level of evidence
II
Keywords
Abbreviations:
GT (Gastrostomy tube), LOS (Length of stay), PED (Pediatric emergency department), PEM (Pediatric emergency medicine), POCUS (Point-of-care-ultrasound), US (Ultrasound)To read this article in full you will need to make a payment
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References
- Case volume and revisits in children undergoing gastrostomy tube placement.J Pediatr Gastroenterol Nutr. 2017; 65: 232-236https://doi.org/10.1097/MPG.0000000000001523
- Gastrostomy tube-related complaints in the pediatric emergency department: identifying opportunities for improvement.Pediatr Emerg Care. 2009; 25: 728-732https://doi.org/10.1097/PEC.0b013e3181bec847
- Emergency department utilization following pediatric gastrostomy tube placement is driven by a small cohort of patients.J Pediatr Surg. 2020; https://doi.org/10.1016/j.jpedsurg.2020.07.016
- Emergency presentations for gastrostomy complications are similar in adults and children.J Pediatr Gastroenterol Nutr. 2021; 72: 141-143https://doi.org/10.1097/MPG.0000000000002920
- Emergency department visits and readmissions among children after gastrostomy tube placement.J Pediatr. 2016; 174 (-45 e2): 139https://doi.org/10.1016/j.jpeds.2016.03.032
- Resource utilization after gastrostomy tube placement: defining areas of improvement for future quality improvement projects.J Pediatr Surg. 2014; 49: 1598-1601https://doi.org/10.1016/j.jpedsurg.2014.06.015
- Postoperative complications in children undergoing gastrostomy tube placement.J Laparoendosc Adv Surg Tech A. 2010; 20: 781-785https://doi.org/10.1089/lap.2010.0191
- Gastrostomy tube replacement in a pediatric ED: frequency of complications and impact of confirmatory imaging.Am J Emerg Med. 2012; 30: 1501-1506https://doi.org/10.1016/j.ajem.2011.12.014
- Percutaneous feeding tube replacement in the ED-are confirmatory x-rays necessary?.Am J Emerg Med. 2009; 27: 519-524https://doi.org/10.1016/j.ajem.2008.04.005
- Replacement of dislodged gastrostomy tubes after stoma dilation in the pediatric emergency department.West J Emerg Med. 2017; 18: 770-774https://doi.org/10.5811/westjem.2017.3.31796
- Use of Point-of-care ultrasound to guide pediatric gastrostomy tube replacement in the emergency department.Pediatr Emerg Care. 2018; 34: 145-148https://doi.org/10.1097/PEC.0000000000001400
- Overuse of fluoroscopic gastrostomy studies in a children's hospital.J Surg Res. 2014; 190: 598-603https://doi.org/10.1016/j.jss.2014.05.010
- Displaced gastrostomy tube in the pediatric emergency department: implementing an evidence-based algorithm and quality improvement project.J Emerg Nurs. 2021; 47: 113-122https://doi.org/10.1016/j.jen.2020.09.007
- Ultrasound-guided gastrostomy tube placement: a case series.J Pediatr Surg. 2017; 52: 1210-1214https://doi.org/10.1016/j.jpedsurg.2017.03.061
- Ultrasound-guided percutaneous 'push-introducer' gastrostomy is a valuable method for accessing the gastrointestinal tract.Nutr Hosp. 2014; 29: 365-369https://doi.org/10.3305/nh.2014.29.2.7127
- Percutaneous sonographic gastrostomy: method, indications, and problems.Am J Gastroenterol. 1998; 93: 941-945https://doi.org/10.1111/j.1572-0241.1998.00283.x
- Percutaneous gastrostomy guided by ultrasound and fluoroscopy.Acta Radiol. 1995; 36: 159-162
- Ultrasound guidance in percutaneous gastrostomy and gastrojejunostomy.Can Assoc Radiol J. 1995; 46: 196-198
- Ultrasound can accurately guide gastrostomy tube replacement and confirm proper tube placement at the bedside.J Emerg Med. 2009; 36: 280-284https://doi.org/10.1016/j.jemermed.2007.11.064
- Point-of-care ultrasound for confirmation of gastrostomy tube replacement in the pediatric emergency department.Intern Emerg Med. 2020; 15: 1075-1079https://doi.org/10.1007/s11739-020-02294-3
Article info
Publication history
Published online: January 28, 2022
Accepted:
January 21,
2022
Received in revised form:
January 12,
2022
Received:
September 22,
2021
Footnotes
☆I have no competing interests to report.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
