Double-blind randomized clinical trial of percutaneous endoscopic gastrostomy <i>versus</i> radiologically inserted gastrostomy in children

Singh, Rashmi R.; Nah, Shireen Anne; Roebuck, Derek; Eaton, Simon; Pierro, Agostino; Curry, Joe; Barnacle, Alex; Chippington, Samantha; Stuart, Sam; Gibson, Colin; Cross, Kate; Stanwell, Joanna; Yardley, Iain; Kiely, Edward M.; Coppi, P De

doi:10.1002/bjs.10687

Cited by 23 publications

(25 citation statements)

References 12 publications

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“…RIG is a procedure commonly performed for long-term enteral nutrition and has been shown to have a similar safety profile to PEG. [2][3][4][5][6][7][8][9] However, there is a great deal of heterogeneity in the way it is performed and the reporting of complications in literature. This study over 5 years at a tertiary center shows that the use of predominantly 18-Fr tubes, with 15 mL water into the balloon, and use of a 3-point gastropexy technique, results in a high level of technical success and a low level of complication.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Studies have shown a similar overall rate of procedural complications between PEG and RIG placement including a recently published prospective randomized controlled trial (RCT) of 214 children where the authors show no significant difference in the complication rate comparing the procedure type. 2,8,9 It should be noted that there is a great deal of heterogeneity in the way that RIG is performed between practitioners and between institutions. The use of gastropexy or not, the number of gastropexy sutures, the size of tube, the tube type (e.g., pigtail or balloon), the use of prophylactic antibiotics, and the necessity of anesthetic involvement will all yield different responses between practitioners.…”

Section: Introductionmentioning

confidence: 99%

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Radiologically Inserted Gastrostomy (RIG) at a Tertiary Center: Periprocedural Safety including Rationalization of Antibiotic Prophylaxis

Clements

Shvarts

Koukounaras

et al. 2021

Journal of Clinical Interventional Radiology ISVIR

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Introduction Long-term percutaneous enteral nutrition forms an important part of treatment for patients with an inability to meet nutrient requirements orally. Radiologically inserted gastrostomy (RIG) is an alternative to the traditionally performed percutaneous endoscopic gastrostomy technique. However, there is marked heterogeneity in the way that RIG is performed. In addition, the role for antibiotic prophylaxis during RIG insertion is not clearly established. This study aimed to assess the safety of RIG insertion using our technique including the role of antibiotics in RIG insertion. Method Retrospective study over 5 years at a tertiary teaching hospital. Periprocedural or early complications within the first 2 weeks of the procedure were collected and correlated with the use of prophylactic antibiotics. Results A total of 116 patients met the inclusion criteria. 18-French tube was used in 96.6%. Note that 58.6% of procedures were done with intravenous sedation. Prophylactic 1 g cefazolin was used in 70 patients with 1 case of infection. Procedures were performed without antibiotics in 46 patients with 3 infections, p = 0.20.There were two major complications (1.7%) consisting of right gastric artery injury requiring embolization and gastric wall injury requiring laparotomy. There were 12 minor complications (10.3%) including 4 cases of infection, 3 of severe pain, 1 of minor bleeding, 2 of early dislodgement, and 2 of leak/bypass of gastric contents around the tube. Conclusion The technique used for RIG insertion at our institution results in a low complication rate. In addition, this study shows no significant difference in early peristomal infection rate with the use of antibiotic prophylaxis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiologically Inserted Gastrostomy (RIG) at a Tertiary Center: Periprocedural Safety including Rationalization of Antibiotic Prophylaxis

Clements

Shvarts

Koukounaras

et al. 2021

Journal of Clinical Interventional Radiology ISVIR

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“…Further procedures 7 patients with PEG and 2 with PBG had conversion of their gastrostomy to a gastrojejunal feeding tube. Of the remaining 98 PEG patients, 44(45%) had a change of gastrostomy tube (PEG-PEG or PEG-BG) under GA at a median 12 months [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] post-primary procedure.…”

Section: Post-operative Complicationsmentioning

confidence: 99%

Open Primary Button Versus Laparoscopic Percutaneous Endoscopic Gastrostomy

Davidson

Lee

Suresh

et al. 2020

J. pediatr. gastroenterol. nutr.

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Open primary balloon gastrostomy (PBG) presents an potentialalternative to percutaneous endoscopic gastrostomy (PEG) in children as it obviates the need for change under general anaesthetic (GA), however the complication profile of PBGcompared to PEG is not well defined.Previous series comparing the two have been hampered by the two groups not being equivalent.Our paediatric surgical centre has offeredPBG as an alternative PEG since 2014. We used a matched case-control study to compare outcomes forPBG and PEG. MethodsPatients undergoing PBG were used as "cases"and matched 1:3 by age and diagnosis to patients undergoing PEG, demographics and clinical data as "controls". Primary outcome was rate of complications classified according to Clavien-Dindo(I-V). Secondary outcomes included time to feed and length of stay. Non-parametric, categorical analyses and multivariate logistic regression were performed. Data here presented as median [IQR]. ResultsWe included 140 patients (35 PBG:105 PEG). The two groups were comparable for gender, weight at surgery and follow-up duration. Median operative time was longer for PBG (43min ], p<0.001). Multivariate analysis demonstrated a statistically significant, higher incidence of symptomatic granulation tissue was more common in PBG (10(29%) vs 6(6%), p=0.0008), this remained significant on multivariate analysis ], p=0.001), nil other complication remained significant nor was overall complication rate statistically different. ConclusionsPBG and PEG have similar overall complication rates, however PBG appears to have a higher incidence of granulation tissue. This observation must be weighed against the need for further GA which is not insignificant in medically complex children.

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“…A PEG can be an option to facilitate the supply of food and medicines, and it has been used successfully in both adult and child care [2]. The insertion of a PEG is a safe method with a low rate of serious complications [3]. PEG feeding through a gastrostomy tube has also been identified as a safe way to prevent malnutrition in children with cancer [2], but there is little data about whether it is comfortable for the child and his or her parent to use a PEG, and the frequency of complications is seldom reported.…”

Section: Introductionmentioning

confidence: 99%

Development of a web-based assessment tool that evaluates the meal situation when a child has a percutaneous endoscopic gastrostomy

et al. 2019

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BackgroundChildren with cancer often suffer side effects from their treatment, for example nausea and vomiting, which can lead to malnutrition. If a child cannot eat orally, a percutaneous endoscopic gastrostomy (PEG) can improve his or her well-being, psychosocial development and growth by enabling the supply of nourishment and facilitating the administration of necessary medicines. Few data exist on children’s comfort when using a PEG. The aim of this study was firstly to develop three versions of a web-based assessment tool in which children, families, and healthcare professionals would be able to register their observations and assessments for evaluating the meal situation when a child has a PEG and secondly to validate the content of the tool.MethodsA qualitative design was chosen with purposive sampling of participants. Five children with cancer, five parents, five registered nurses and five paediatricians participated first in an interview and then in a member check of the web-based tool. The data were analysed with manifest qualitative content analysis.ResultsThe results highlighted four categories of issues which needed to be revised in the web-based tool: words which were difficult for the participants to understand, items which contained several questions, items which needed to be split into more items to be answerable and the layout of the questionnaire. The web-based tool was revised according to the categories, and then a member check evaluated and finally confirmed the revisions.ConclusionsA web-based tool may be able to evaluate the meal situation when a child with cancer has a PEG. The tool may be able to detect early failures of the PEG, facilitating early action from the healthcare professionals in supporting the child and his or her parents in their care of the PEG. In the long run, this web-based tool may also be able to increase the quality of care of children living with a PEG.Electronic supplementary materialThe online version of this article (10.1186/s12887-019-1447-1) contains supplementary material, which is available to authorized users.

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Double-blind randomized clinical trial of percutaneous endoscopic gastrostomy versus radiologically inserted gastrostomy in children

Abstract: PEG and RIG are both safe methods of gastrostomy insertion with a low rate of major complications. Registration number: NCT01920438 ( http://www.clinicaltrials.gov).

Cited by 23 publications

References 12 publications

Radiologically Inserted Gastrostomy (RIG) at a Tertiary Center: Periprocedural Safety including Rationalization of Antibiotic Prophylaxis

Radiologically Inserted Gastrostomy (RIG) at a Tertiary Center: Periprocedural Safety including Rationalization of Antibiotic Prophylaxis

Open Primary Button Versus Laparoscopic Percutaneous Endoscopic Gastrostomy

Development of a web-based assessment tool that evaluates the meal situation when a child has a percutaneous endoscopic gastrostomy

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