ESPE Abstracts

Background: Hyperinsulinism (HI) is a major cause of hypoglycaemia during childhood and is related with neurological damage. Among the therapeutic options for HI patients with limited fasting tolerance are intensive feeding regimes, requiring continuous overnight and regular daytime feeds via gastrostomy. Two types of gastrostomy device are commonly used: Freka Percutaneous (FPEG) and Mic-key button (MB). MB is expected to have a higher rate of unintentional dislodgement than PEG.

Aim: To evaluate safety and efficacy of FPEG vs MB, in children with HI.

Method: We identified 33 HI patients with gastrostomy formation. We sent a survey and received responses from 16 patients. Parental consent was obtained. We measured the number of patients with FPEG which switched to MB when older. We also collected data retrospectively regarding complications before and after the device change. Also, parental anxiety about each device management was evaluated.

Results: All patients were informed regarding the gastrostomy device type before insertion. Fifteen patients (94%) had FPEG as initial device, and one patient had MB (6%). Complications related to the gastrostomy were reported in 19% (3/16) including gastrostomy site infection (1/16), lump (1/16) and buried bumper (2/16). All patients had replacement of their original device at two years after insertion, with 50% (8/16) choosing to remain on FPEG (8/16), 44% (7/16) changing to MB and one 6% (1/16) some other device (Mic-Key transgastric jejunal tube). After the gastrostomy replacement, complications including infection and tube migration into bowel, reported in 19% of our cases (2 FPEG, 1 MB). These complications affected the glycaemic control in 13% (2/16, 1 FPEG, 1 MB) of our cohort. No cases with unintentional dislodgement were reported. There was no parental anxiety about the gastrostomy device in 94% of the cases, while 31% (5/16) of parents reported that gastrostomy has been reassuring for the management of their child’s hypoglycaemia due to HI.

Conclusion: Among our HI patients, we noticed that gastrostomy could ensure euglycaemia and minimize parental anxiety. Complications were low for both FPEG and MB. However, observational studies with larger number of patients are needed to assess safety, efficacy and impact in quality of life of MB vs PEG in HI patients. Meanwhile, we recommend FPEG as first choice of gastrostomy in HI patients requiring overnight feeds. FPEG, due to its non-traction removable design is expected to have lower risk of unintentional dislodgement. A structured risk assessment should be considered to support decision for change to MB where appropriate.