Gastrostomy insertion in children: percutaneous endoscopic or percutaneous image-guided?

Abstract

Background/Purpose Gastrostomy insertion in children can be performed in many ways, but which is the best technique remains uncertain. This study evaluates the outcome of percutaneous endoscopic gastrostomy (PEG) and image-guided gastrostomy (IG). Methods We reviewed children who had either PEG (n = 136) inserted by pediatric surgeons or IG (n = 195) inserted by interventional radiologists in our hospital between May 2004 and July 2008. Gastrostomy-related complications were given scores ranging from 20 for major complications (eg, peritonitis, gastrointestinal bleed, and visceral injury) to 1 for minor (eg, site infection and tube migration), and total score per month of follow-up was calculated per patient. Results Conversion to laparoscopic or open gastrostomy was more frequent in PEG versus IG ( P = .001). Fewer PEG patients (28%) had complications than did IG (47%) ( P = .001). One PEG patient developed a gastrocolic fistula. In the IG group, 2 patients had transverse colon puncture, 1 had intraperitoneal tube detachment, and 1 had upper gastrointestinal bleeding. When scored and adjusted by length of follow-up, PEG had lower scores compared with IG, indicating a better outcome ( P = .03). These findings were supported by zero-inflated Poisson regression analysis. Conclusion Major complications were rare and observed more frequently after IG. Minor complications were observed in both procedures but were significantly less common in PEG.