One‐Step Insertion of Low‐Profile Gastrostomy in Pediatric Patients vs Pull Percutaneous Endoscopic Gastrostomy

Göthberg, G; Björnsson, Sigge

doi:10.1177/0148607114567202

Cited by 23 publications

(46 citation statements)

References 16 publications

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“…Another postulated benefit of the push technique is decreased risk for peristomal infections because the tube is not exposed to the oral bacterial flora during insertion. Although the push technique is associated with a lower peristomal infection rate than PEG-P in adults 5 , a similar advantage has not been shown in pediatric patients 6 7 .…”

Section: Introductionmentioning

confidence: 96%

“…Recently, PEG placement with the push technique and T-fastener gastropexy (PEG-T) has been introduced in pediatric patients 6 , and this particular method has gained popularity. So far, there are only a few studies that have evaluated the PEG-T technique in pediatric patients 6 7 8 , therefore, we wanted to report our initial experience with the PEG-T with particular emphasis on peri- and postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…Despite this policy, we found a significant difference between tube and button groups with the latter having significantly fewer anaesthetics. This is supported in similar studies [5][6][7]. It is also important to consider the laparoscopic approach to placing a primary button, which, of course, also only requires one anaesthetic [3].…”

Section: Discussionmentioning

confidence: 75%

“…1). The PEG-B was carried out as per manufacturer's instructions (MIC-KEY Introducer Kit (Kimberly-Clark Corp, Roswell, Georgia) and as previously described by Göthberg and Björnsson [5] (Fig. 2).…”

Section: Operative Techniquementioning

confidence: 99%

“…for safe placement of gastrostomy tubes, with combinations of open, laparoscopic, and fluoroscopic techniques [4]. A further concern in children associated with the PEG technique is the need for repeated general anaesthetics (GA) to exchange the tube either with a new tube or a button device The percutaneous endoscopic primary button gastrostomy (PEG-B) approach attempts to address this [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous endoscopic primary gastrostomy button (PEG-B) is safe and significantly reduces the need for general anaesthetic tube changes in children when compared to the percutaneous endoscopic gastrostomy tube (PEG-T): a prospective study

et al. 2019

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Purpose To compare the clinical outcomes and financial implications of the percutaneous endoscopic primary button gastrostomy (PEG-B) insertion using T-fastener technique with the percutaneous endoscopic gastrostomy tube insertion (PEG-T) using a push-pull technique. Methods Data were prospectively gathered on 122 patients undergoing gastrostomy insertion over a 3-year period (2016-2019). Our primary outcome measure was the number of second general anaesthetics (GA) required in relation to the gastrostomy tube. Secondary outcome measures included complications and cost. Results Following exclusion criteria of lap assisted, concomitant procedure or insufficient data, 105 patients were analysed. Sixty-two (61%) PEG-B were inserted using a T-fastener technique. Forty-three (39%) PEG-T were inserted using a pushpull technique. Two (3.2%) patients with a PEG-B required a GA change or reinsertion of device compared with 31 (72%) of the PEG-T group who underwent a tube change under GA to either a button or a new tube in the study period (p < 0.01). The requirement for GA changes in the PEG-T group results in a considerably higher cost for this approach than the PEG-B approach. There was no difference between the number of peri-operative and post-operative complications between the two groups; however, the PEG-T group appeared to have higher rate of major operative complications (n = 3 bowel injuries). Whereas in the PEG-B group: complications were minor technical issues and displacement requiring replacement under fluoroscopy. In the follow-up period, rates of granulation tissue requiring intervention and stoma site infections were equivalent between groups. Conclusion The PEG-B technique of placing a gastrostomy avoids the need for a replacement of gastrostomy tube under GA and its associated risk of repeat GA and financial cost. Furthermore, the technique is potentially associated with fewer major complications. We conclude, therefore, that the PEG-B approach reduces the interventional and financial burden on the patient, their family, and the healthcare provider, and could be considered as a safe alternative for paediatric gastrostomy insertion.

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Single‐stage percutaneous endoscopic gastrostomy

Niță¹,

Amil‐Dias²,

Urs³

et al. 2021

Practical Pediatric Gastrointestinal Endoscopy

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One‐Step Insertion of Low‐Profile Gastrostomy in Pediatric Patients vs Pull Percutaneous Endoscopic Gastrostomy

Cited by 23 publications

References 16 publications

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

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

Percutaneous endoscopic primary gastrostomy button (PEG-B) is safe and significantly reduces the need for general anaesthetic tube changes in children when compared to the percutaneous endoscopic gastrostomy tube (PEG-T): a prospective study

Single‐stage percutaneous endoscopic gastrostomy

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