Abstract
Abstract Background/purpose: There is no consensus when it comes to the best procedure or device used for gastrostomy creation in pediatrics. We compared the complications encountered with different gastrostomy techniques. Methods: All paediatric patients having had a gastrostomy procedure between 2004 and 2016 were retrospectively reviewed. Overall, serious and local complication rates at six months were compared between PEG-button (PEG-B), pull-PEG tube (PEG-T) and surgical gastrostomies with buttons (SG-B). Results: Complications occurred in 44.6% of the patients. The rate of overall complications (71.4% vs. 50.0%, p = 0.02) as well as minor complications (93.3% vs. 69.0%, p < 0.01) was higher in the PEG-B group (63 patients) compared to the PEG-T group (58 patients) but similar to the SG-B group (83 patients). Serious complications mainly occurred in the PEG-T group (31.0% vs. 6.7%, p < 0.01). Risk factors for overall complications were being a female (Odds ratio (OR) 2.62, p < 0.01) and a concomitant fundoplication (OR 8.94, p = 0.04), whereas serious complications were favoured by the use of a G-tube (OR 3.78, p = 0.01). Conclusions: A PEG-B is a simple and safe way for enteral nutrition, with a slightly higher rate of local, but less serious, complications than the classic pull-PEG technique.
Highlights
Gastrostomy is a recognized solution for long-term enteral feeding for paediatric patients with failure to thrive
Forty nine patients had surgical gastric tube procedures (SG-T group); for information, their baseline characteristics are reported in Table 1 with the three other groups, but no further comparison was made with this group
If the efficiency of gastrostomy feeding was the same in all groups after 6 months, it appeared that the use of a G-tube was at risk of serious surgical complications compared to a button, regardless of the technique used
Summary
Gastrostomy is a recognized solution for long-term enteral feeding for paediatric patients with failure to thrive. Indications include multiple conditions: feeding disorders (eg: neurologically impaired children), dependency on fluid and nutritional supplementation, congenital or acquired pathologies in which oral intake is impeded (eg: oesophageal atresia, craniofacial surgery) and patients with long-term inadequate intake (eg: cancer, cystic fibrosis). Various techniques have been described for gastrostomies: Percutaneous endoscopic gastrostomy (PEG), traditional Stem open procedure, PEG with fluoroscopy, laparoscopic technique, laparoscopic assisted PEG. Since the first description by Gauderer in 1980, PEG has considerably evolved and become the gold standard for long-term enteral access [1,2]. The Pull technique, characterized by the use of a feeding tube, having been the subject of many improvements has be-.
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