P2.Q322: Is The Need for Surgical Gastrostomy Revision a Modifiable Event?

Background: Gastrostomy tubes play a pivotal role in addressing nutritional needs, especially among children with congenital anomalies. However morbid complications can occur with long term use of gastrostomy tubes leading to gastrostomy revision with re-siting (GR). This study aims to understand the patterns of gastrostomy revision at a large Children’s hospital in the US to ascertain if this may be a modifiable event.

Methods: A retrospective review of electronic medical records was conducted after IRB approval. All patients who had gastrostomy revision (GR) from January 2010 to January 2024 were included. Patients who had GR as part of another procedure (e.g. fundoplication) were excluded. Data collected included demographics, anthropometric measurements (BMI and WAZ), diagnosis leading to initial gastrostomy placement (IGP), indication for GR, as well as immediate pre- and post-revision gastrostomy tube length. Descriptive and inferential statistics were applied.

Results: During the study period, 111 patients had a GR: 46% female and 54% male. The mean age at IGP was 2 years old, with 71% undergoing IGP before 2 years old. The most prevalent indications for IGP were: 45% airway and esophageal pathology, 34% neuromuscular disorders, 34% intra-abdominal disorders. The mean interval between IGP and GR was 64 months. The average age at GR was 9 years. Excessive leaking was the primary indication for GR in 85 patients (76%) with 44% also having gastric prolapse. Additionally, 22 patients (20%) had GR due to migration of the gastrostomy tract to the coastal margin with somatic growth, presenting with site pain (n=7), leaking (n=10), or both gastric prolapse and continuous leaking (n=5). The average increase in gastrostomy length at revision was 0.61 cm for patients who presented with excessive leaking indicating tract compression as a contributing factor to GR and 0.34 cm for those who presented with migration toward the costal margin. A significant difference in the average change in gastrostomy tube length before and after GR was found among anthropometric groups (p ≤0.05). Specifically, the average difference in tube length before and at revision was 0.25 cm (SD=0.5) for underweight patients, 0.56 cm (SD=0.7) for normal weight patients, and 0.93 cm (SD=0.9) among overweight and obese patients.

Conclusion: Long term use of gastrostomy tubes necessitates rigorous surveillance to avoid the need for re-siting. The gastrostomy device length needed to be increased in those having revision, implicating tract compression as a contributing factor, particularly in obese patients. In those having pain and leaking due to impingement on the costal margin, locating the gastrostomy as inferior as possible at IGP is supported as growth leads to site migration toward the costal margin over years. Lastly, anticipatorily increasing the tube length to prevent tract compression over the years is strongly supported as a modifiable factor to avoid reoperation.