Gill Anne E, Gallagher Nicholas, McElhanon Barbara O, Painter Amy R, Gold Benjamin D, Hawkins C Matthew
Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, 1364 Clifton Road NE, Suite D112, Atlanta, GA, 30322, USA.
Pediatr Radiol. 2018 Jun;48(6):882-888. doi: 10.1007/s00247-018-4082-3. Epub 2018 Feb 8.
De novo low-profile gastrojejunostomy tubes in pediatric patients offer less external catheter bulk and decreased propensity for dislodgement as children become more mobile. While small cohort studies have evaluated de novo placement of coaxial, adjustable-length, percutaneous gastrojejunostomy (GJ) tubes in children, placement of de novo low-profile GJ tubes in pediatric patients has not been analyzed.
This study evaluates technical feasibility, safety and clinical efficacy of percutaneous, retrograde placement of de novo low-profile GJ tubes in infants and children.
Following institutional review board approval, all de novo low-profile GJ tube placements in patients were retrospectively reviewed between May 2014 and May 2017. Technical parameters of fluoroscopy time, tube size, T-fasteners and complications were recorded. Clinical data, including age, indication, weight gain and complications, were analyzed.
Thirty-four de novo low-profile GJ tubes were placed in 34 patients (median age: 9.4 months, range: 2 months-11.8 years; median pre-procedural weight: 7.5 kg, range: 2.9-31.6 kg). Twenty-one 14-Fr and 13 16-Fr GJ tubes were placed with technical success rate of 100%. Average weight gain 3 months' post procedure was 1.1 kg (range: 0.3-4.8 kg) and average weight percentile for age increase was 9.6% (range: -48.9% to 53.5%). One major complication occurred following balloon inflation within the tract causing pain requiring urgent replacement of the GJ tube. Minor complications occurred in 11 patients (32%): accidental dislodgement (n=9), skin irritation (n=4), tube dysfunction (n=2), leakage (n=2) and tube migration into the esophagus (n=1).
Percutaneous, antegrade, image-guided placement of de novo low-profile GJ tubes is technically feasible, safe and clinically efficacious in appropriately selected pediatric patients.
对于儿科患者，新型低轮廓胃空肠造口管减少了外置导管的体积，并且随着儿童活动增多，其移位倾向降低。虽然小型队列研究评估了儿童同轴、可调节长度的经皮胃空肠造口术（GJ）管的初次放置情况，但尚未分析儿科患者新型低轮廓GJ管的放置情况。
本研究评估在婴幼儿和儿童中经皮逆行放置新型低轮廓GJ管的技术可行性、安全性和临床疗效。
经机构审查委员会批准，对2014年5月至2017年5月期间所有患者的新型低轮廓GJ管初次放置情况进行回顾性研究。记录透视时间、导管尺寸、T形夹等技术参数以及并发症情况。分析临床数据，包括年龄、适应证、体重增加情况和并发症。
34例患者放置了34根新型低轮廓GJ管（中位年龄：9.4个月，范围：2个月至11.8岁；术前中位体重：7.5kg，范围：2.9至31.6kg）。放置了21根14Fr和13根16Fr的GJ管，技术成功率为100%。术后3个月平均体重增加1.1kg（范围：0.3至4.8kg），年龄平均体重百分位数增加9.6%（范围：-48.9%至53.5%）。1例主要并发症发生在球囊在通道内充气后，导致疼痛，需要紧急更换GJ管。11例患者（32%）出现轻微并发症：意外移位（n=9）、皮肤刺激（n=4）、导管功能障碍（n=2）、渗漏（n=2）和导管移入食管（n=1）。
在适当选择的儿科患者中，经皮顺行、影像引导下放置新型低轮廓GJ管在技术上是可行的、安全的且临床有效。
