P0729 SHOULD SINGLE STAGE PEG BUTTONS BECOME THE PROCEDURE OF CHOICE FOR PEG PLACEMENT IN CHILDREN?

Abstract

Introduction: Since its introduction in 1980 the percutaneous gastrostostomy tube (PEG-T) rapidly became the preponderant modality for gastrostomy (GT) placement in children. The ability to replace the PEG-T with a skin level GT (“button”) as early as 6 weeks postoperatively further improved the acceptance of GT placement by both patients and their parents. Since the early 1990’s a modification to the PEG kit and technique (PEG-B) has allowed button placement at the time of initial GT placement. This pull technique however has been poorly studied, and accepted into clinical practice, perhaps due to problems with the early models. Methods: Our objective was to retrospectively review the experience and outcomes of the PEG-B at the Nemours Children’s Clinic Jacksonville (NCC-J) as compared to traditionally placed PEG-T’s. The NCC-J billing computer was searched between 1997–2002 identifying children who underwent either PEG-T or PEG-B placement. All children received similar pre-operative and postoperative care. PEG-T patients were given the option of converting their GT’s to buttons as early as 6 weeks postoperatively. PEG-B patients had their first GT change when the original button failed or was removed permanently. The medical charts for both patient groups were reviewed and compared for: age at time of GT placement, underlying diagnoses, length of hospitalization, post-operative complications and duration from time of placement till first GT replacement. IRB approval for this study was granted Results: 145 and 93 patients were identified in the PEG-B and PEG-T groups respectively. Encephalopathy, prematurity and chronic lung disease were the 3 most prevalent primary diagnoses in each group. The average age and weight at time of GT placement was 47mths and 11.9kg in the PEG-B group and 38.7mths and 10.1kg in the PEG-T group. Postoperative complication profiles were similar in each group. Granulation tissue was the most frequently observed complication in each group (PEG-B: 31, PEG-T: 21, p: ns) followed by feeding intolerance (PEG-B: 4, PEG-T: 10, p<0.025)) and cellulitis (PEG-B: 3, PEG-T: 4). The interval till first tube change was 327 and 78 days for the PEG-B and PEG-T patients respectively (p<0.0001). Conclusion: Single stage PEG buttons offer the advantage of significantly delaying the first GT change which is often either uncomfortable and painful for the child or necessitates an additional anesthetic. Although postoperative granulation tissue was seen more frequently in this group, it did not prevent recommending this as the primary modality for PEG placement in our patients. Single stage PEG buttons should be considered as the procedure of choice for PEG placement in children.