Clinical Outcomes After Gastrostomy Tube Removal in Children: Risk Factors for Complications & Growth Outcome

Abstract

Abstract Purpose To determine the incidence of and risk factors for complications after gastrostomy tube removal in children and to investigate whether complications are associated with growth outcome. Methodology: Medical records of 108 patients, who underwent gastrostomy removal and gastrostomy site closure, between January 2014 to July 2022 at a single institution, were reviewed. Clinical factors were analysed for association with complications and growth outcomes. Results Complications occurred in 39% (42/108) of patients. Persistent gastrocutaneous fistula (GCF) (20/108, 18%) and perioperative complications (16/82, 20%) were most frequent. Attempted non-operative closure (NOC), PPI use, and steroid use were more frequent in patients with complications (64.3% vs 28.8%, p = 0.001; 57.3% vs 32.3%, p = 0.029; 29.3% vs 12.5%, p = 0.033 respectively). Patients with persistent GCF had longer mean duration of gastrostomy placement (40.45 ± 35.36 vs 15.96 ± 16.94 months, p=0.008) and greater occurrence of pre-existing non-reflux gastrointestinal disease (40% vs 12%, p=0.038). Mean growth z-scores were maintained at 6 months, 18 months and 5 years follow-up in patients with and without complications. Conclusion Attempted NOC, PPIs, and steroids were risk factors for complications after gastrostomy removal. Longer duration of gastrostomy placement and non-reflux gastrointestinal disease were risk factors for persistent GCF. Complications were not associated with poorer growth outcome.