Complications of one-step button percutaneous endoscopic gastrostomy in children

Abstract

To assess the complications of one-step button percutaneous endoscopic gastrostomy (B-PEG) and determine risk factors for developing stomal infections or gastropexy complications. MethodsA retrospective study of 679 children who underwent a B-PEG procedure in a single tertiary care center over a 10-year period to December 2020 was conducted. Patient characteristics, early complications (occurring ≤7 days after the procedure), late complications (> 7 days after the procedure), and outcomes were collected from medical records. A list of potential risk factors, including age at procedure, prematurity, underlying neurological disease, and undernutrition, was determined a priori. ResultsAt least 1 year of follow-up was available for 513 patients. Median follow-up duration was 2.8 years (interquartile range 1.0-4.9 years). Major complications were rare (< 2%), and no death was related to B-PEG. Early complications affected 15.9% of the study population, and 78.0% of children presented late complications. Development of granulation tissue was the most common complication followed in frequency by tube dislodgment and T-fastener complications. Only 24 patients (3.5%) presented stomal infections. Young age at the time of PEG placement (odds ratio (OR) 2.34 [1.03-5.30], p = .042) was a risk factor for developing peristomal infection. T-fastener migration occurred in 17.3% of children, and we found underlying neurological disease was a protective factor (OR 0.59 [0.37-0.92], p = .019). ConclusionB-PEG is a safe method and associated with a low rate of local infection. However, T-fasteners are associated with signi cant morbidity and require particular attention in young and premature infants. What Is KnownPercutaneous endoscopic gastrostomy (PEG) is the preferred method to provide long-term enteral nutrition in children to prevent malnutrition. The Pull-PEG method is still the most commonly used with complications , such as stomal infection. Since its description, only a few studies have reported postoperative complications of one-step button PEG (B-PEG).

Complications after pediatric percutaneous endoscopic gastrostomy: comparison of the push and pull technique

“…The rate of T-fastener-related complications is significant and clearly a disadvantage of the technique. 8 10 20 We share the same clinical experience that optimal tightness and duration of the T-fasteners seem to decrease the complications. 10 In our department, the percutaneous and endoscopic push technique remains the primary method for gastrostomy placement, and laparoscopy is reserved for cases in which safety of this method is in doubt during the procedure.…”

“…The push technique was found to have the lowest rate of complications. In the largest retrospective series 8 including 679 children who underwent PEG with the push technique, the median follow-up time was 2.8 years and rates of major, early, and late complications were <2%, 15.9%, and 78.0%, respectively. In the aforementioned studies, complications have been reported non-uniformly, making comparison with our results challenging.…”

“…New cohort studies have recently been published to support this trend. 8 10 Comparative studies on different PEG techniques do not uniformly show that the push technique is superior to other techniques; however, none of the studies have shown it to be inferior in children when analyzed for safety. 9 11 13 When comparing the complications of all different gastrostomy techniques (including laparoscopy and radiographically assisted) in children, the optimal procedure remains controversial.…”

“…In children, the overall PEG complication rate varies between 21% and even 78%, depending on the follow-up time and how the complications are described. 8 10–14 Outcomes from both the pull and push technique operations have been compared, and it seems that in children, the newer push technique is at least as safe as the traditional technique. 13 15 Complications seem to be common, but fortunately, minor complications form the notable majority, and major complications occur in only 10–13% of cases.…”

“…Recent studies have highlighted the safety of this one-step technique. [8][9][10] WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Various complications are related to percutaneous endoscopic gastrostomy procedures in children. ⇒ The push technique is increasingly used and replacing the pull technique, but the rate and type of complications associated with the push technique remain scarcely reported.…”