Tuğba KOCA, Levent DUMAN, Selim DERECİ, Ayşe Çiğdem SİVRİCE, Mustafa AKÇAM

Çocuklarda perkütan endoskopik gastrostomi: tek merkez deneyimi

Amaç: Çocuk Gastroenteroloji Bilim Dalı'nda üç yıllık dönemde perkütan endoskopik gastrostomi işlemi uygulanmış çocukların demografik verilerinin, komplikasyon oranlarının irdelenmesi ve aile memnuniyetinin sorgulanması amaçlanmıştır. Gereç ve Yöntemler: Mart 2011-Mart 2014 yılları arasında birimimizde perkütan endoskopik gastrostomi işlemi uygulanan olguların demografik verileri, komplikasyonları ve izlem bulguları hasta dosyalarından geriye dönük olarak incelendi. İstatistiksel değerlendirme ki-kare ve paired t testi ile yapıldı. Bulgular: Üç yıl içinde 34 hastaya 47 perkütan endoskopik gastrostomi ve perkütan endoskopik gastrostomi ilişkili işlem gerçekleştirilmişti. Olguların ortanca yaşı 2,25 yıl (3 ay-16 yıl, 1 ve 3. çeyrek=1,0-6,0), ağırlık ortalaması 13,07±8,6 kg (3 kg-47 kg) idi. Olguların işlem öncesi beden ağırlığı Z skoru ortalaması -2,26±1,20 , boy Z skorları ortalaması -2,25±0,96 (-3,85-0,98) saptandı. Yirmi dört olgunun işlem sonrası 12. aydaki boy ve beden ağırlığı Z skorlarına ulaşılabildi. Bu 24 hastanın perkütan endoskopik gastrostomi kateteri takıldıktan bir yıl sonra beden ağırlığı Z skoru ortalamasında -2,41'den -1,07'ye (p=0,000) ve boy Z skoru ortalamasında -2,29'den -1,99'a (p=0,000) olacak şekilde anlamlı artış saptandı. Olguların çoğunluğunu nörolojik ve metabolik hastalığı olan çocuklar oluşturmaktaydı (sırasıyla %64,7 ve %26,5). İşlem sonrasında bir hastada peritona mama kaçağı, üç hastada yerel stoma enfeksiyonu ve izlemde bir hastada "Buried bumper (gömülmüş tampon) sendromu" geliştiği saptandı. Perkütan endoskopik gastrostomi öncesi anti-reflü ilaç kullanan hasta sayısı 16 (%47,1) iken, perkütan endoskopik gastrostomi sonrası bu sayı 18'e (%52,9) yükseldi (p=0,62). Perkütan endoskopik gastrostomi sonrası sık aspirasyon pnömonisi geçiren beyin felci tanılı bir hastaya Nissen fundoplikasyonu uygulandığı ve bir olgunun perkütan endoskopik gastrostomi kateterinin çıkarıldığı saptandı. Ebeveynlerin işlem sonrası peruktan endoskopik gastrostomi ile ilgili görüşleri olumlu idi. Çıkarımlar: Perkütan endoskopik gastrostomi, çocuklarda ve ergenlerde olduğu gibi, süt çocuklarında da oldukça başarılı ve güvenilir bir yöntemdir. Ailelerin işlem sonrası perkütan endoskopik gastrostomi ile ilgili görüşleri olumludur

Percutaneous endoscopic gastrostomy in children: a single center experience

Aim: The aim of this study was to evaluate the demographic data and complication rates in children who had undergone percutaneous endoscopic gastrostomy in a three-year period in our Division of Pediatric Gastroenterology and to interrogate parental satisfaction.Material and Methods: The demographic data, complications and follow-up findings of the patients who had undergone percutaneous endoscopic gastrostomy between March 2011 and March 2014 were examined retrospectively using medical files. Results: Forty seven percutaneous endoscopic gastrostomy and percutaneous endoscopic gastrostomy related procedures were performed in 34 children during a three-year period. The median age of the patients was 2.25 years (3 months-16 years, first and third quartiles=1.0-6.0) and the mean body weight was 13.07±8.6 kg (3 kg-47 kg). Before percutaneous endoscopic gastrostomy procedure, the mean weight z score was -2.26±1.2 and the mean height z score was -2.25±0.96 (-3.85-0.98). The follow-up mean height and weight Z scores at the 12th month after the percutaneous endoscopic gastrostomy procedure could be reached in 24 patients. A significant increase in the mean weight Z score from -2.41 to -1,07 (p=0.000) and in the mean height Z score from -2.29 to -1.99 (p=0.000) was found one year after percutaneous endoscopic gastrostomy catheter was placed in these 24 patients. Patients with neurological and metabolic diseases constituted the majority (64.7% and 26.5% respectively). Peritoneal leakage of food was detected in one patient and local stoma infections were detected in three patients after the procedure. During the follow up period, "Buried bumper syndrome" was observed in one patient. Following percutaneous endoscopic gastrostomy, the number of patients using anti-reflux medication increased from 16 (47.1%) to 18 (52.9%) (p=0.62). One patient with cerebral palsy who had aspiration pneumonia after percutaneous endoscopic gastrostomy insertion had undergone Nissen fundoplication. Percutaneous endoscopic gastrostomy tube was removed in a patient. The parents had positive views related with percutaneous endoscopic gastrostomy after the procedure. Conclusions: Percutaneous endoscopic gastrostomy is a substantially successful and reliable method in infants as well as in children and adolescents. The parents had positive views related with percutaneous endoscopic gastrostomy after the procedure

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