St-Louis Etienne, Safa Nadia, Guadagno Elena, Baird Robert
Division of Pediatric Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
J Pediatr Surg. 2018 May;53(5):946-958. doi: 10.1016/j.jpedsurg.2018.02.022. Epub 2018 Feb 8.
Gastrostomy tubes are a common adjunct to the care of vulnerable pediatric patients. This study systematically evaluates the epidemiology and risk-factors for gastrocutaneous fistulae (GCF) after gastrostomy removal in children and reviews treatment options focusing on nonoperative management (NOM).
After protocol registration (CRD-42017059565), multiple databases were searched. Studies describing epidemiology in children and GCF treatment at any age were included. Critical appraisal was performed (MINORS risk-of-bias assessment tool). One-sided meta-analysis was executed to estimate efficacy of therapeutic adjuncts using a random-effects model.
Sixteen articles evaluating pediatric GCF were identified. 44% defined GCF as persistence >1month which occurred in 31±7% of cases. Risk factors for pediatric GCF include age at gastrostomy, timing of removal, open technique, and fundoplication. Mean MINORS score was 0.60±0.16. Seventeen additional studies were identified reporting 142 patients undergoing NOM (endoscopic, systemic, and local therapies), and one pediatric comparative study was identified. Overall aggregate proportion of GCF closure after any NOM is 77% (80% success rate in local/systemic therapies; 75% success rate in endoscopic approaches). No adverse events were reported.
Persistent GCF complicates the management of gastrostomies in 1/3 of children with predictable risk factors. Several treatment options exist that obviate the need for general anesthesia. Their efficacy is unclear. Further prospective investigations are clearly warranted.
III - Systematic Review and Meta-Analysis Based on Retrospective Case Control Studies.
胃造瘘管是儿科脆弱患者护理中常用的辅助手段。本研究系统评估了儿童胃造瘘管拔除后胃皮肤瘘（GCF）的流行病学及危险因素，并综述了以非手术治疗（NOM）为主的治疗选择。
在方案注册（CRD-42017059565）后，检索了多个数据库。纳入描述儿童流行病学及任何年龄GCF治疗的研究。进行了严格评价（MINORS偏倚风险评估工具）。采用随机效应模型进行单向荟萃分析，以评估治疗辅助手段的疗效。
确定了16篇评估儿科GCF的文章。44%将GCF定义为持续时间>1个月，其发生率为31±7%。儿科GCF的危险因素包括胃造瘘时的年龄、拔除时间、开放技术和胃底折叠术。MINORS平均评分为0.60±0.16。另外确定了17项研究，报告了142例接受NOM（内镜、全身和局部治疗）的患者，并确定了1项儿科对比研究。任何NOM后GCF闭合的总体汇总比例为77%（局部/全身治疗成功率80%；内镜治疗成功率75%）。未报告不良事件。
持续性GCF使1/3具有可预测危险因素的儿童胃造瘘管理复杂化。有几种治疗选择可避免全身麻醉的需要。其疗效尚不清楚。显然有必要进行进一步的前瞻性研究。
III - 基于回顾性病例对照研究的系统评价和荟萃分析。
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