Bhambani Shiloni, Phan Tammy H, Brown Lance, Thorp Andrea W
Kaiser Permanente Medical Center, Department of Pediatrics, Fremont, California.
Loma Linda University Medical Center, Loma Linda, California.
West J Emerg Med. 2017 Jun;18(4):770-774. doi: 10.5811/westjem.2017.3.31796. Epub 2017 Apr 19.
A dislodged gastrostomy tube (GT) is a common complaint that requires evaluation in the pediatric emergency department (ED) and, on occasion, will require stoma dilation to successfully replace the GT. The objective of this study was to describe the frequency that stoma dilation is required, the success rate of replacement, complications encountered, and the techniques used to confirm placement of the GT after dilation.
We conducted a retrospective medical record review of children 0-18 years who presented to the pediatric ED from February 2013 through February 2015 with a dislodged GT that required stoma dilation by pediatric emergency physicians with serially increasing Foley catheter sizes prior to successful placement of the GT.
We reviewed a total of 302 encounters in 215 patients, with 97 (32%) of the encounters requiring stoma dilation prior to replacing a GT. The median amount of dilation was 2 French between the initial Foley catheter size and the final GT size. There was a single complication of a mal-positioned balloon that was identified at the index visit. No delayed complications were encountered. We performed confirmation of placement in all patients. The two most common forms of confirmation were aspiration of gastric contents (56/97 [58%]) followed by contrast radiograph in 39 (40%).
The practice of serial dilation of a gastrostomy stoma site to allow successful replacement of a gastrostomy tube in pediatric patients who present to the ED with a dislodged gastrostomy tube is generally successful and without increased complication. All patients received at least one form of confirmation for appropriate GT placement with the most common being aspiration of gastric contents.
胃造口管（GT）脱出是常见问题，需要在儿科急诊科（ED）进行评估，有时还需要进行造口扩张才能成功更换GT。本研究的目的是描述造口扩张的需求频率、更换成功率、遇到的并发症以及扩张后确认GT位置的技术。
我们对2013年2月至2015年2月期间因GT脱出而到儿科ED就诊的0至18岁儿童进行了回顾性病历审查，这些儿童在成功放置GT之前需要儿科急诊医生使用Foley导尿管尺寸逐步增加的方法进行造口扩张。
我们共审查了215例患者的302次就诊情况，其中97次（32%）就诊在更换GT之前需要进行造口扩张。初始Foley导尿管尺寸与最终GT尺寸之间的扩张中位数为2F。在初次就诊时发现了1例球囊位置不当的并发症。未遇到延迟并发症。我们对所有患者进行了放置确认。两种最常见的确认形式是抽吸胃内容物（56/97 [58%]），其次是39例（40%）进行造影检查。
对于因胃造口管脱出而到ED就诊的儿科患者，通过对胃造口部位进行系列扩张以成功更换胃造口管的做法通常是成功的，且不会增加并发症。所有患者至少接受了一种确认GT放置合适的方法，最常见的是抽吸胃内容物。
