Gastrostomy tube placement in infants and children: is there a preferred technique?

Akay, Begum; Capizzani, Tony; Lee, Alice; Drongowski, Robert A.; Geiger, James D.; Hirschl, Ronald B.; Mychaliska, George B.

doi:10.1016/j.jpedsurg.2010.02.079

Cited by 111 publications

(108 citation statements)

References 8 publications

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“…[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The combined approach is known as laparoscopic-assisted PEG insertion (LAPEG). 5,12 This technique appears to be associated with reduced complications, but does not necessarily negate the need for postoperative tube exchanges for a skin-level device.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic-assisted percutaneous endoscopic gastrostomy: insertion of a skin-level device using a tear-away sheath

Livingston

Pepe

Jones

et al. 2015

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Background: This study describes our experience with the placement of a skin-level gastrostomy device (MIC-KEY) in a single procedure. Methods:We identified infants, children and young adults who underwent laparoscopicassisted percutaneous endoscopic gastrostomy (LAPEG) tube insertion between October 2009 and June 2013. The steps of this procedure include upper endoscopy, single-port laparoscopy, gastropexy via percutaneous T-fasteners and placement of a skin-level gastrostomy device (MIC-KEY) using a "push" technique with a tearaway sheath. Results:We included 92 patients in our study. Mean age was 3.7 years (range 3 wk-5 yr), and mean weight was 11.2 (range 2.8-54) kg. Median procedural time was 20 (range 12-76) minutes. Total median duration for the most recent 25 procedures was lower than that of the first 25 (62 v. 79 min, p = 0.004). There were no intraoperative complications or conversions to open surgery. Postoperative complications were observed in 6 (6.5%) patients. Three retained T-fasteners were assessed endoscopically (n = 1) or removed via local excision (n = 2). Two patients experienced early dislodged feeding tubes that were replaced via interventional radiology (n = 1) or repeat LAPEG (n = 1). There was also 1 intra-abdominal fluid collection that was drained percutaneously but ultimately required a laparotomy and washout. There were no major complications in the most recent 50 procedures. Conclusion:Our results suggest that LAPEG is a safe, minimally invasive procedure for infants, children and young adults. This approach allows for immediate use of a skin-level gastrostomy device without the need for postoperative tube exchanges.Contexte : Cette étude décrit notre expérience avec la pose d'un dispositif de gastrostomie au niveau de la peau (MIC-KEY) en une seule intervention.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic-assisted percutaneous endoscopic gastrostomy: insertion of a skin-level device using a tear-away sheath

Livingston

Pepe

Jones

et al. 2015

cjs

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“…3); acresce que esta técnica, por disponibilizar visualização direta de todo o procedimento, permite eleger com maior acuidade o local da gastrostomia e apresenta uma incidência significativamente menor de complicações graves. 19 Contudo, está por estabelecer qual das técnicas (PEG vs laparoscopia) apresenta o binómio risco-benefício mais vantajoso. Para a colocação de uma PEG não é imprescindível a anestesia geral em bloco operatório, podendo ser efetuada com segurança sob sedação e anestesia local, inclusivamente na criança.…”

Section: Gastrostomiasunclassified

Vias para Nutrição Artificial na Criança (I): Acessos Entéricos

Estevão‐Costa

2014

Acta Med Port

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RESUMOO aporte nutricional adequado é crucial na abordagem terapêutica de múltiplos estados mórbidos, o que justifica o recurso frequente e crescente a vias de acesso específicas para nutrição entérica e parentérica. No presente artigo é realizada uma revisão da literatura relevante acerca de indicações, modalidades, eficácia e complicações das vias de acesso entérico na criança. Os fatores a considerar na decisão entre acesso gástrico e acesso pós-pilórico, e entre colocação de sonda nasogástrica e gastrostomia são criteriosamente discutidos. Perante indicação para acesso gástrico de longa duração, a gastrostomia endoscópica percutânea é a técnica mais utilizada dada a sua eficácia e segurança, embora a morbilidade associada não seja desprezível; a colocação de gastrostomia laparoscópica emerge como uma alternativa potencialmente vantajosa. Palavras-chave: Criança; Nutrição Entérica; Intubação Gastrointestinal; Gastrostomia; Jejunostomia; Laparoscopia. ABSTRACTAppropriate nutritional support is crucial in the therapeutic approach of multiple conditions, which justifies the frequent and increasing use of specific access routes for enteral and parenteral nutrition. This article reviews the relevant literature concerning indications, procedures, effectiveness and complications of enteral access routes in children. The decision between gastric and postpyloric access, and between nasogastric tube and gastrostomy is thoroughly discussed. Percutaneous endoscopic gastrostomy is the most commonly used technique when a long-term gastric access is required, given its efficacy and safety although the associated morbidity is not negligible; laparoscopic gastrostomy emerges as a potentially advantageous alternative.

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“…A review from our institution in 2010 found a slightly lower complication rate for laparoscopic gastrostomy compared to PEG tube placement. [15] One disadvantage is that it can be challenging to bring up the stomach through the thicker abdominal wall (>2cm thick) of larger children, so laparoscopic gastrostomy tube placement is generally reserved for younger, smaller children. To perform a laparoscopic gastrostomy, the abdomen is prepped and draped in the usual sterile fashion.…”

Section: Laparoscopic Gastrostomymentioning

confidence: 99%

“…[6,15,17] The primary reason for this difference is the direct visualization of the interface between the gastric and abdominal walls that the laparoscopic technique allows. Unfortunately, the laparoscopic gastrostomy cannot be performed on children with thicker abdominal walls.…”

Section: Laparoscopic Pegmentioning

confidence: 99%

“…Some studies have shown laparoscopic placement to be associated with less complications than PEG because of direct visualization of the stomach and greater ability to secure the stomach to the anterior abdominal wall. [15] Less severe remote complications result in frequent outpatient evaluations following the initial post-operative visit. Granulation tissue formation, tube erosion, and skin ulceration produce significant discomfort for the child, cause bleeding and leakage of the gastric contents, and lead to frequent interruption of feeds.…”

Section: Complicationsmentioning

confidence: 99%

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