Gastrostomy in Pediatric Patients

Gastrostomy is one of the most common procedures performed in the pediatric population. The first gastrostomy was performed over 150 years ago, with the first successful attempts in children occurring in the late 1800’s. [1] The procedure and its use in Pediatric Surgery have significantly evolved over the past several decades with the introduction of endoscopic and laparoscopic techniques to surgical practice. [2-7] These advances have resulted in the ability to perform these operations quickly, safely, and minimally invasively, while also expanding the applications for gastrostomy. The primary indication for gastrostomy in infants and children is the need for long-term (>3-6 months) primary or supplemental enteral feeding (Table 1). This group can be subdivided into the two most common groups of gastrostomy tube candidates: those with severe dysphagia and those with failure to thrive (FTT). Most of these children with severe dysphagia have neurologic dysfunction that impairs normal swallowing. Potential sources of FTT include short gut syndrome, GI malabsorption, malignancy, trauma, chronic lung disease, and congenital heart disease, among others. Gastrostomy may also be considered in patients with pulmonary disease due to frequent aspiration of oral feeds. Rarely, a child can require gastrostomy to administer a non-palatable diet or medication. Finally, for children with primary GI abnormalities, gastrostomy placement may be a preferred means of gastric decompression.