Title

Mitigation of Stomach Dehiscence Risk During Gastrostomy Tube Changes – A Retrospective Analysis of Patient Outcomes

Document Type

Poster

Publication Date

2015

Disciplines

Medicine and Health Sciences

Abstract

Stomach dehiscence from the abdominal wall is a serious and potentially life-threatening complication of gastrostomy tube changes. A prospective series of 1136 gastrostomy tube changes in 415 different patients is examined to identify high-risk patients and provide evidence to support common practice patterns. Each gastrostomy change was analyzed for type of tube changed, patient demographics, patient diagnoses, and complications resulting from changes. Complications were stratified as minor complication (bleeding, infection, pain, leaking site, loss of tube requiring dilation of tract to reinsert), moderate complications (dislodged tube requiring anesthesia to replace and major complications (intra-peritoneal insertion, intra-peritoneal leak). Percutaneous Endoscopic Gastrostomy (PEG) Tube conversion to any type of tube was the only type of tube change to have a significantly (p=0.0036) higher risk of dehiscence (6.7%) vs. non-PEG change (0.39%). Children with Failure to thrive and neurologic impairment had significantly higher overall complication rates (p<0.005) but not higher gastric dehiscence. Aspiration of gastric contents through the newly placed tube as a confirmatory test for intra-gastric placement was found to have a positive predictive value of 99.3% with a sensitivity of 99.7% and specificity of 33%. We conclude that non-PEG tube changes can be performed safely at the bedside and that positive gastric aspirate is a positive predictor of adequate tube placement with high sensitivity. PEG tube changes have a significant risk for dehiscence. This evidence supports endoscopic supervision during PEG tube changes. Utility

Rights

Copyright all authors

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