A comparison of pediatric gastrostomy tube placement techniques.

Abstract

This study aimed to compare different techniques for placement of gastrostomy tubes in a pediatric population. A retrospective review was performed for patients less than 18years of age who underwent gastrostomy tube placement at a single academic children's hospital between 2010 and 2012. Techniques for gastrostomy placement included Open Stamm, percutaneous endoscopic gastrostomy (PEG), fluoroscopy guided, laparoscopic, and laparoscopic assisted PEG. Pre-operative characteristics of patients and post-operative outcomes were compared between techniques. Most patients underwent an Open Stamm (43%) or PEG (39%). There were significant differences between groups with respect to primary diagnoses, prior surgeries, and ASA classification. Major complications were rare, with less than 3% requiring reoperation within 30days; however, minor complications and returns to the emergency department were common. Unintentional tube dislodgements occurred in 22% of all patients, with Open Stamm technique identified as an independent predictor of unintentional dislodgement (p<0.0001). Although conclusions from this retrospective analysis are limited due to heterogeneity between groups, open Stamm gastrostomy placement in children was associated with increased negative outcomes including unintentional tube dislodgements, returns to the emergency department, and need for reoperation within 30days. Prospective analysis of the various techniques is needed to confirm that minimally invasive techniques for gastrostomy tube placement are associated with a less complicated post-operative course.