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World J Gastrointest Surg. Sep 27, 2023; 15(9): 1871-1878
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.1871
Advances and challenges of gastrostomy insertion in children
Rana Bitar, Amer Azaz, David Rawat, Mohamed Hobeldin, Mohamad Miqdady, Seifeleslam Abdelsalam
Rana Bitar, Amer Azaz, Mohamad Miqdady, Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi 767451, United Arab Emirates
Rana Bitar, Amer Azaz, Mohamad Miqdady, Faculty of Medicine, Khalifa University, Abu Dhabi 767451, United Arab Emirates
David Rawat, Pediatric Gastroenterology, Barts Health NHS Trust, London E1 1BB, United Kingdom
Mohamed Hobeldin, Seifeleslam Abdelsalam, Pediatric Surgery, Sheikh Khalifa Medical City, Abu Dhabi 767451, United Arab Emirates
Author contributions: Bitar R made substantial contributions to the conception and design of the work, interpretation of data, drafting, writing and revising the manuscript critically for important intellectual content and approved the final version to be published, and agrees to be accountable for all aspects of the work; Azaz A, Rawat D, Hobeldin M, Miqdady M, and Abdelsalam S made substantial contributions to the design of the work, acquisition and interpretation of data and revising the manuscript critically for important intellectual content, and approved the final version to be published and agree to be accountable for all aspects of the work.
Conflict-of-interest statement: There is no conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rana Bitar, MBBS, Assistant Professor, Pediatric Gastroenterology, Sheikh Khalifa Medical City, Al Karamah Street, Abu Dhabi 767451, United Arab Emirates. drranab@doctors.org.uk
Received: February 6, 2023
Peer-review started: February 6, 2023
First decision: May 9, 2023
Revised: June 13, 2023
Accepted: July 18, 2023
Article in press: July 18, 2023
Published online: September 27, 2023
Processing time: 228 Days and 2.7 Hours
Abstract

When oral feeding cannot provide adequate nutritional support to children, enteral tube feeding becomes a necessity. The overall aim is to ultimately promote appropriate growth, improve the patient’s quality of life and increase carer satisfaction. Nasogastric tube feeding is considered appropriate on a short-term basis. Alternatively, gastrostomy feeding offers a more convenient and safer feeding option especially as it does not require frequent replacements, and carries a lower risk of complications. Gastrostomy tube feeding should be considered when nasogastric tube feeding is required for more than 2-3 wk as per the ESPEN guidelines on artificial enteral nutrition. Several techniques can be used to insert gastrostomies in children including endoscopic, image guided and surgical gastrostomy insertion whether open or laparoscopic. Each technique has its own advantages and disadvantages. The timing of gastrostomy insertion, device choice and method of insertion is dependent on the local expertise, patient requirements and family preference, and should be individualized with a multidisciplinary team approach. We aim to review gastrostomy insertion in children including indications, contraindications, history of gastrostomy, insertion techniques and complications.

Keywords: Laparoscopic gastrostomy; Percutaneous endoscopic gastrostomy; Laparoscopic-assisted gastrostomy; Laparoscopic-assisted percutaneous endoscopic gastrostomy; Radiologic gastrostomy; Open gastrostomy

Core Tip: Gastrostomy tubes are inserted to support the long-term nutritional needs of children when oral feeding becomes compromised. Gastrostomy insertion has evolved over the last century to involve multiple feeding devices and various insertion techniques. The insertion technique and device choice need to be selected after careful consideration of patient background medical history, patient needs, available facilities and after adequate counseling in a multi-disciplinary team setting. In this review we will present the indications, contraindications, history, advances, insertion techniques, challenges and complications of gastrostomy insertion in children.