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  • Title: Image-guided percutaneous gastrostomy in neonates with esophageal atresia.
    Author: Aziz D, Chait P, Kreichman F, Langer JC.
    Journal: J Pediatr Surg; 2004 Nov; 39(11):1648-50. PubMed ID: 15547827.
    Abstract:
    BACKGROUND: Neonates with esophageal atresia may require a gastrostomy before definitive repair. Most surgeons do this procedure using the Stamm technique through a laparotomy. The authors describe a new technique for percutaneous placement of a gastrostomy in these infants and report their preliminary results. METHODS: For children with esophageal atresia and a tracheoesophageal fistula (TEF), the air-filled stomach is localized fluoroscopically and accessed using a standard percutaneous technique. For those with pure esophageal atresia, a transhepatic needle is used to instil air into the stomach. Once the stomach is distended, the gastrostomy tube is inserted under fluoroscopy. RESULTS: Fourteen neonates with esophageal atresia had a percutaneous gastrostomy tube placed. Eleven had esophageal atresia and a TEF, and 3 had pure esophageal atresia with a gasless abdomen requiring the transhepatic approach. There were no intraoperative or major postoperative complications, but there were 5 minor early postoperative complications and 2 minor late postoperative complications. CONCLUSIONS: Percutaneous gastrostomy insertion is a safe technique for neonates with esophageal atresia and can be used even in children with pure esophageal atresia who have a gasless abdomen. This technique does not require laparotomy and appears to be associated with a low rate of complications.
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