Mo1208 Laparoscopic Gastrostomy Is Safer Than Percutaneous Endoscopic Gastrostomy in Children: Results of a Systematic Review and Meta-Analysis

Abstract

Background: A gastrostomy is frequently performed in children who require long-term enteral feeding. Nowadays gastrostomy placement is a minimally invasive procedure via either percutaneous endoscopic gastrostomy (PEG) or laparoscopic assisted gastrostomy (LAG). Both procedures are widely used in pediatric patients. However, no consensus exists on which type of approach is best practice in these patients. Aim: The aim of this study was to determine if PEG or LAG is the most effective and safe procedure in pediatric patients requiring a gastrostomy Method: A systematic review and meta-analysis was performed according to the guidelines in the PRISMA-statement. PubMed, EMBASE, and the Cochrane Library were searched to identify eligible articles. Results were pooled in meta-analyses and expressed as risk ratios (RR). Results: Our extensive literature search provided 2,342 articles. After title, abstract and full-text screening five original studies comparing PEG to LAG placement in children were identified. All studies had retrospective study designs. The completion rate (PEG 98%; LAG 100%) and time to full-enteral feeds (PEG 0.7 and LAG 0.8 days) of both procedures were similar. No studies reported data comparing the efficacy of feeding via the gastrostomy or its effect on developing gastroesophageal reflux (GER). Major complications, such as intraperitoneal leakage (RR 0.28; p=0.36; after tube exchange RR 3.14; p=0.28) and persistence of the gastrocutaneous fistula after removal of the gastrostomy tube (RR 0.94; p =0.92 ) were as frequently encountered after both PEG and LAG. However, PEG was associated with significantly more adjacent bowel injury (RR=5.55; p= 0.05), early tube dislodgement (RR=7.44; p=0.02), and complications requiring reintervention under general anesthesia in the operating room (RR=2.79; p=0.0008). The risk of developing minor complications was similar after both PEG and LAG placement. Conclusion: This systematic review and meta-analysis demonstrates a lack in studies comparing the effect of PEG and LAG on the efficacy of feeding via the gastrostomy tube and postoperative GER. However, major complications such as adjacent bowel injury, early tube dislodgements and complications requiring reintervention under general anesthesia in the operating room were significantly less frequent after LAG. Therefore, we conclude that LAG is the safest approach and should be the first choice in children requiring gastrostomy placement.