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Fascetti-Leon F.,University of Padua | Gamba P.,University of Padua | Dall'Oglio L.,Digestive Surgery and Endoscopy Unit | Pane A.,Digestive Surgery and Endoscopy Unit | And 12 more authors.
Digestive and Liver Disease | Year: 2012

Background: Percutaneous endoscopic gastrostomy is the preferred way to achieve an artificial feeding route for patients requiring long-term enteral nutrition. Although the procedure is well-standardized, it carries early and late complications. Aim: To establish the mortality and morbidity of this technique in a large cohort of children. Methods: A multi-centre prospective clinical data collection from children undergoing percutaneous endoscopic gastrostomy tube implantation has been conducted from January 2004 to December 2007. Previous abdominal surgery was the only exclusion criterion. Follow-up visits were carried out at 1, 3, 6, 12, and 24. months after the procedure. Results: 239 children (males, 55.2%; mean age 6.05 ± 6.1. years) were enrolled from nine tertiary Italian centres. Major complications occurred in 8 patients (3.3%). The cumulative incidence of complications was 47.7% at 24. months. The presence of thoraco-abdominal deformity was an independent predictor of complications at 12. months. No risk factors were identified in association to complications during the 1st tube replacement. Conclusion: In children undergoing percutaneous endoscopic gastrostomy placement minor complications are common, while severe morbidities are rare. Accurate follow up is essential to recognize every complication, in particular when risk factors such as thoraco-abdominal deformity exist. © 2012 Editrice Gastroenterologica Italiana S.r.l.

Romeo E.,Digestive Surgery and Endoscopy Unit | Foschia F.,Digestive Surgery and Endoscopy Unit | De Angelis P.,Digestive Surgery and Endoscopy Unit | Caldaro T.,Digestive Surgery and Endoscopy Unit | And 6 more authors.
Journal of Pediatric Surgery | Year: 2011

Background/Purpose: Congenital esophageal stenosis (CES) is a rare malformation. Endoscopic dilations represent a therapeutic option. This study retrospectively evaluated the efficacy and safety of a conservative treatment of CES. Patients and Methods: Patients diagnosed with CES since 1980 by a barium study or endoscopy were reviewed. Endoscopic ultrasonography (Olympus UM-3R-20-MHz radial miniprobe, Olympus Corporation, Tokyo, Japan), available from 2001, allowed for the differential diagnosis of tracheobronchial remnants (TBR) and fibromuscular hypertrophy (FMH) CES. All children underwent conservative treatment by endoscopic dilations (hydrostatic and Savary). Results: Forty-seven patients (20 men) had CES. Fifteen were associated with esophageal atresia; and 8, with Down syndrome. Mean age at the diagnosis was 28.3 months (range, 1 day to 146 months). Symptoms were solid food refusal, regurgitation, vomiting, and dysphagia. Congenital esophageal stenosis was located in the distal esophagus. Endoscopic ultrasonography demonstrated TBR and FMH in 6 patients. One hundred forty-eight dilations in 47 patients were performed. The stenosis healed in 45 (95.7%). Complications were 5 (10.6%) esophageal perforations, hydrostatic (3/32, or 9.3%), and Savary (2/116, or 1.7%). At follow-up, 1 patient with FMH CES and 1 patient with TBR CES required operation for persistent dysphagia. Conclusions: The conservative treatment yielded positive outcomes in CES. Endoscopic ultrasonography allows for a correct diagnosis of TBR/FMH CES. A surgical approach should be reserved for CES not responsive to dilations. © 2011 Elsevier Inc.

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