Laparoscopic Gastrostomy Is Superior to Percutaneous Endoscopic Gastrostomy Tube Placement in Children Less Than 5 years of Age

Petrosyan, Mikael; Khalafallah, Adham M.; Franklin, Ashanti; Doan, Tina; Kane, Timothy D.

doi:10.1089/lap.2016.0099

Cited by 33 publications

(17 citation statements)

References 12 publications

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“…Laparoscopic gastrostomy (LG) is an alternative gastrostomy technique considered to be safe and effective in previous pediatric reports, with a few procedure-related major complications. 14,15 LG can be preferable over PEG in small infants especially if a concomitant fundoplication is needed. 15 Mortalities occurred due to associated morbidities at a high rate in our series.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous endoscopic gastrostomy in small infants unable to swallow safely

Durakbaşa

Ozumut

Orhon

et al. 2020

Pediatrics International

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Background: Data about percutaneous endoscopic gastrostomy (PEG) insertions in small infants are limited, and most studies include older children. We aimed to evaluate the safety of PEG placement in infants weighing ≤5 kg together with their follow-up results. Methods: A retrospective evaluation was made of records between January 2005 and December 2019. Results: A total of 43 infants were ≤5 kg at the time of PEG insertion. The mean age was 5 AE 3 (19 days-16 months) months and the mean weight was 4.3 AE 0.6 (2.7-5.0) kg. The primary diagnoses were neurological disorders in 25, metabolic disorders in nine, cleft palates in four, muscular disorders in four, and a cardiac disorder in one. All procedures were completed successfully. A self-resolving pneumoperitoneum developed in one (2.3%). The tube was extruded in six (14%) patients postoperatively which required suture-approximation of the skin and subcuticular tissues. The tube was removed in four (9%) patients with achievement of oral feeds on the long-term. Eighteen (42%) died of primary diseases. The tubes were in situ for a median of 12.4 (17 days-73 months) months in these patients. A total of 20 (46.5%) patients are currently being followed up and their tubes are in situ for a median of 50.3 (4.7 month-9.8 years) months. Conclusions: Percutaneous endoscopic gastrostomy placement is safe in small infants with associated morbidities. Complications related to the procedure are within acceptable limits. The accidental extrusion of the tube was a special consideration in this patient group. The overall mortality was high because of underlying primary diseases.

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Section: Discussionmentioning

confidence: 99%

Percutaneous endoscopic gastrostomy in small infants unable to swallow safely

Durakbaşa

Ozumut

Orhon

et al. 2020

Pediatrics International

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“…A prior study from our institution examined gastrostomy placement in infants less than one year of age and found that despite placement in a healthier cohort, PEG had more morbid and more costly complications, specifically a 3.8% risk of gastrocolic fistula, compared to laparoscopic gastrostomy [5]. In addition, Petrosyan et al reviewed gastrostomy placements in children less than five years of age, finding that the risk of major complications with PEG (3.3%) was significantly higher than that of laparoscopic gastrostomy with or without a concomitant fundoplication (0.7%) [6]. We hypothesize that young children could be at increased risk of complications during PEG placement due to thinner tissues that are easier to transilluminate through, in particular the transverse colon or gastrocolic omentum.…”

Section: Discussionmentioning

confidence: 99%

“…PEG has the benefit of generally shorter operative time than SG. However, this difference must also be weighed against the second general anesthetic sometimes needed for the later exchange of a PEG tube for a low-profile button gastrostomy tube [ 4 , 6 , 11 , 12 ]. The first gastrostomy tube change after SG can typically be done in the outpatient setting without an anesthetic.…”

Section: Discussionmentioning

confidence: 99%

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Variability in the Method of Gastrostomy Placement in Children

et al. 2020

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Although gastrostomy placement is one of the most common procedures performed in children, the optimal technique remains unclear. The purpose of this study was to evaluate variability in the method of gastrostomy tube placement in children in the United States. Patients <18 years old undergoing percutaneous endoscopic gastrostomy (PEG) or surgical gastrostomy (SG) (including open or laparoscopic) from 1997 to 2012 were identified using the Kids’ Inpatient Database. Method of gastrostomy placement was evaluated using a multivariable mixed-effects logistic regression model with a random intercept term and a patient-age random-effect term. A total of 67,811 gastrostomy placements were performed during the study period. PEG was used in 36.6% of entries overall and was generally consistent over time. PEG placement was less commonly performed in infants (adjusted odds ratio [aOR] 0.30, 95%CI 0.26–0.33), children at urban hospitals (aOR: 0.38, 95%CI 0.18–0.82), and children cared for at children’s hospitals (aOR 0.57, 95%CI 0.48–0.69) and was more commonly performed in children with private insurance (aOR 1.17, 95%CI 1.09–1.25). Dramatic variability in PEG use was identified between centers, ranging from 0% to 100%. The random intercept and slope terms significantly improved the model, confirming significant center-level variability and increased variability among patients <1 year old. These findings emphasize the need to further evaluate the safest method of gastrostomy placement in children, in particular among the youngest patients in whom practice varies the most.

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“…Lastly, LAPG allows direct insertion of a low-profile device, 8 which later can be replaced without the need for sedation or general anesthesia in contrast to several types of PEGs. 9 Although LAPG has several advantages compared with PEGs, LAPG has higher costs and longer operating time. 10,11 Even though LAPG has gained widespread use, there are still relatively few studies that have addressed the complication rate after LAPG.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Gastrostomy Placement in Children Has Few Major, but Many Minor Early Complications

2019

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Introduction Laparoscopic gastrostomy (LAPG) is an increasingly popular alternative to more traditional gastrostomy techniques. This study evaluates early postoperative complications following LAPG and investigates risk factors for gastrostomy complications. Materials and Methods Retrospective study of patients <16 years undergoing LAPG from 2005 to 2018. Early postoperative complications (<30 days) were grouped as gastrostomy-related or general and graded according to the Clavien-Dindo classification for surgical complications. Results A total of 104 patients, of which 54 (52%) had neurological impairment (NI), were included. Median age and weight were 1.2 years (1 day–15.2 years) and 8.9 kg (3.4–36), respectively. Operating time was median 37 minutes (19–86) and shorter in the second half of the patients (46 vs. 35 minutes, p = 0.04). A total of 40 (38%) patients experienced 53 gastrostomy-related complications. Of these, seven complications needed surgical treatment; severe leakage (2), too short gastrostomy button (1), feeding difficulties (1), gastric outlet obstruction (1), omentum trapped in umbilical port sutures (1), and suspected fascial defect (1). Stoma infection and granulation tissue were reported in 13 and 12%, respectively. Tube dislodgement occurred in six patients and was managed with bedside reinsertion in all. Gastrostomy-related complications were less frequent in NI patients (46 vs 22%, p = 0.01). Conclusion LAPG is a safe procedure with few major complications, but a high rate of minor complications. Operating time declined during the study period, and NI patients had fewer gastrostomy-related complications.

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Laparoscopic Gastrostomy Is Superior to Percutaneous Endoscopic Gastrostomy Tube Placement in Children Less Than 5 years of Age

Cited by 33 publications

References 12 publications

Percutaneous endoscopic gastrostomy in small infants unable to swallow safely

Percutaneous endoscopic gastrostomy in small infants unable to swallow safely

Variability in the Method of Gastrostomy Placement in Children

Laparoscopic Gastrostomy Placement in Children Has Few Major, but Many Minor Early Complications

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