Initial experience with percutaneous endoscopic gastrostomy with T-fastener fixation in pediatric patients

Abstract

Background and study aims Insertion of a percutaneous endoscopic gastrostomy (PEG) with push-through technique and T-fastener fixation (PEG-T) has recently been introduced in pediatric patients. The T-fasteners allow a primary insertion of a balloon gastrostomy. Due to limited data on the results of this technique in children, we have investigated peri- and postoperative outcomes after implementation of PEG-T in our department. Patients and methods This retrospective chart review included all patients below 18 years who underwent PEG-T placement from 2010 to 2014. Main outcomes were 30-day postoperative complications and late gastrostomy-related complications. Results In total, 87 patients were included, and median follow-up time was 2.4 years (1 month – 4.9 years). Median age and weight at PEG-T insertion were 1.9 years (9.4 months – 16.4 years) and 10.4 kg (5.4 – 33.0 kg), respectively. Median operation time was 28 minutes (10 – 65 minutes), and 6 surgeons and 3 endoscopists performed the procedures. During the first 30 days, 54 complications occurred in 41 patients (47 %). Most common were peristomal infections treated with either local antibiotics in 11 patients (13 %) or systemic antibiotics in 11 other patients (13 %). 9 patients (10 %) experienced tube dislodgment. Late gastrostomy-related complications occurred in 33 patients (38 %). The T-fasteners caused early and late complications in 9 (10 %) and 11 patients (13 %), respectively. Of these, 4 patients (5 %) had subcutaneously migrated T-fasteners which were removed under general anesthesia. Conclusion We found a high rate of complications after PEG-T. In particular, problems with the T-fasteners and tube dislodgment occurred frequently after PEG-T insertion.

Endoscopic management of enteral tubes in adult patients – Part 2: Peri- and post-procedural management. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…Various methods have been proposed to prevent tube dislodgment; these include sophisticated tube designs such as low profile "button-type" tubes [128,129]. In a recent RCT, balloon-tube dislodgment was significantly less frequent in a group of patients who underwent weekly measurement of the water volume within the balloon followed by tube replacement at 3-monthly intervals [130].…”

Safety and efficacy of laparoscopy‐assisted percutaneous endoscopic gastrostomy in infants and small children weighing less than 10 kg: A comparison with larger patients

“…The frequency of T‐fastener–related complications in their report was much higher than in the present study. In their report, the suture locks were removed later at 3 to 4 weeks postoperatively, compared to 1 to 2 weeks in our patients 11 . Livingston et al changed from cutting the T‐fastener sutures 3 to 4 weeks postoperatively to 5 days after LAPEG in pediatric patients.…”

“…There have been some reports regarding T‐fastener migration 10‐12 . Kvello et al reported the outcomes of PEG with T‐fastener gastropexy in 92 pediatric patients.…”

“…There have been some reports regarding T-fastener migration. [10][11][12] Kvello et al reported the outcomes of PEG with T-fastener gastropexy in 92 pediatric patients. Of those patients, 9 (11%) developed early T-fastenerrelated complications such as infection at the site of the external suture lock, and 11 (13%) developed late T-fastener-related complications such as T-fastener migration.…”

“…In their report, the suture locks were removed later at 3 to 4 weeks postoperatively, compared to 1 to 2 weeks in our patients. 11 Livingston et al changed from cutting the T-fastener sutures 3 to 4 weeks postoperatively to 5 days after LAPEG in pediatric patients. After they made this change, they did not experience any T-fastener-related complications.…”