Comparison of major complications in children after laparoscopy-assisted gastrostomy and percutaneous endoscopic gastrostomy placement: a meta-analysis

Sandberg, Filip; Viktorsdóttir, Margrét Brands; Salö, Martin; Stenström, Pernilla; Arnbjörnsson, Einar

doi:10.1007/s00383-018-4358-6

Cited by 58 publications

(42 citation statements)

References 19 publications

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“…While some studies have evaluated the efficacy and side effects of gastrostomy from surgical or medical perspectives, still limited data are available on both aspects in the same series and on a long-term follow-up [10,11,12]. To our knowledge, no data are available about the incidence of a serious complication such as dumping syndrome, and limited data are available about the eventual need for a fundoplication procedure in a cohort of children all previously evaluated before gastrostomy positioning for gastro-esophageal reflux, as in this study.…”

Section: Introductionmentioning

confidence: 99%

Gastrostomy Placement and Management in Children: A Single-Center Experience

et al. 2019

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BACKGROUND: To prevent malnutrition and food aspiration in children with chronic neuromuscular problems, enteral nutrition provided by gastrostomy is recommended. Long-term follow-up data about surgical and medical complications of PEG are available, but few papers have addressed all of the issues in the same series. METHODS: This retrospective study enrolled patients under 18 years who had a gastrostomy tube placed at our institution between 2003 and 2017. The aim is to evaluate outcomes after gastrostomy placement, focusing both on surgical complications (early and late), and its effect on their nutritional status, on the prevention of pulmonary infections, and their parents’ opinion. RESULTS: Eighty-four gastrostomies were placed in total (35 F; 49 M). Seventy-seven patients had a severe neurocognitive impairment (GMFCS 5). The principal indication for gastrostomy was severe dysphagia (53.3%). No gastrostomy-related death was observed. Early surgical complications were observed in five of 84 (5,9%) patients; late complications were observed in 15 of 84 (17.8%) patients. Twenty-two patients were diagnosed with subsequent gastroesophageal reflux; five patients developed dumping syndrome (6%). Complete medical follow-up data were available for 45 patients. A progressive improvement of nutritional status was observed in 29 patients, and 11 maintained the same percentile; the occurrence of respiratory infections and need for hospitalization decreased. In 90% of cases, parents were fully satisfied with the g-tube. CONCLUSION: This study confirms the positive nutritional outcomes of gastrostomy-tube with an associated small risk of surgical complications and a reduction in the number of respiratory infections, with most parents scoring their experience as positive.

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Section: Introductionmentioning

confidence: 99%

Gastrostomy Placement and Management in Children: A Single-Center Experience

et al. 2019

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“…Another recent systematic review and meta-analysis including five retrospective studies found that while completion rates and minor complications were similar between the 550 PEG placements and 483 laparoscopic gastrostomy placements examined, significantly more bowel injuries, early tube dislodgements, and complications requiring reintervention under general anesthesia occurred after PEG placement [4]. Finally, the most recent systematic review confirmed these findings, showing that in a total of eight studies examining 1550 patients undergoing gastrostomy placement, the odds of major complications were more than three-fold higher with PEG (5.4%) compared to laparoscopic gastrostomy (1.0%) [2].…”

Section: Discussionmentioning

confidence: 81%

“…PEG is now well established as an effective method of gastrostomy placement in children and adults after its initial description by Gauderer in 1980 [1]. While some studies have shown similar safety between PEG and SG in children, several meta-analyses have recently reported a higher rate of complications with PEG [2][3][4]. These safety concerns have been most pronounced among the youngest patients [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…The goals of this study were (1) to measure the use of PEG and SG over time, (2) to identify the patient population in which PEG is most frequently being used, and (3) to identify potential variability in PEG use between centers providing care to children. We hypothesized that (1) the use of PEG in children has increased over time and that (2) the use of PEG varies significantly between centers.…”

Section: Introductionmentioning

confidence: 99%

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Variability in the Method of Gastrostomy Placement in Children

et al. 2020

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Although gastrostomy placement is one of the most common procedures performed in children, the optimal technique remains unclear. The purpose of this study was to evaluate variability in the method of gastrostomy tube placement in children in the United States. Patients <18 years old undergoing percutaneous endoscopic gastrostomy (PEG) or surgical gastrostomy (SG) (including open or laparoscopic) from 1997 to 2012 were identified using the Kids’ Inpatient Database. Method of gastrostomy placement was evaluated using a multivariable mixed-effects logistic regression model with a random intercept term and a patient-age random-effect term. A total of 67,811 gastrostomy placements were performed during the study period. PEG was used in 36.6% of entries overall and was generally consistent over time. PEG placement was less commonly performed in infants (adjusted odds ratio [aOR] 0.30, 95%CI 0.26–0.33), children at urban hospitals (aOR: 0.38, 95%CI 0.18–0.82), and children cared for at children’s hospitals (aOR 0.57, 95%CI 0.48–0.69) and was more commonly performed in children with private insurance (aOR 1.17, 95%CI 1.09–1.25). Dramatic variability in PEG use was identified between centers, ranging from 0% to 100%. The random intercept and slope terms significantly improved the model, confirming significant center-level variability and increased variability among patients <1 year old. These findings emphasize the need to further evaluate the safest method of gastrostomy placement in children, in particular among the youngest patients in whom practice varies the most.

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“…For patients with severe failure to thrive and/or significant allergies, a gastrostomy tube provides stable access. However, while gastrostomy tube placement is generally associated with a low rate of complications in pediatric patients [5,6], the underlying connective tissue disorder in LDS may pose additional risks which would outweigh the benefits. We therefore undertook a retrospective cohort study of LDS patients treated at our institution to evaluate the safety and efficacy of gastrostomy tube placement in this patient population.…”

Section: Introductionmentioning

confidence: 99%

Safety and outcome of gastrostomy tube placement in patients with Loeys-Dietz syndrome

Frischmeyer‐Guerrerio

MacCarrick

Dietz

et al. 2020

BMC Gastroenterol

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Background: Loeys-Dietz syndrome (LDS) is a systemic connective tissue disease (CTD) associated with a predisposition for intestinal inflammation, food allergy, and failure to thrive, often necessitating nutritional supplementation via gastrostomy tube. Poor wound healing has also been observed in in some patients with CTD, potentially increasing the risk of surgical interventions. We undertook to determine the safety and efficacy of gastrostomy tube placement in this population. Methods: We performed a retrospective cohort study of 10 LDS patients who had a total of 12 gastrostomy tubes placed. Results: No procedural complications occurred, although one patient developed buried bumper syndrome in the near post-procedural time period and one patient had a small abscess at a surgical stitch. Most patients exhibited improvements in growth, with a median immediate improvement in BMI Z-score of 0.2 per month following the institution of gastrostomy tube feedings. Those with uncontrolled inflammation due to inflammatory bowel disease or eosinophilic gastrointestinal disease showed the least benefit and in some cases failed to demonstrate significant weight gain despite nutritional supplementation. Conclusions: Gastrostomy tube placement (surgical or endoscopic) is a generally safe and a reasonable therapeutic option for patients with LDS despite their underlying CTD.

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Comparison of major complications in children after laparoscopy-assisted gastrostomy and percutaneous endoscopic gastrostomy placement: a meta-analysis

Cited by 58 publications

References 19 publications

Gastrostomy Placement and Management in Children: A Single-Center Experience

Gastrostomy Placement and Management in Children: A Single-Center Experience

Variability in the Method of Gastrostomy Placement in Children

Safety and outcome of gastrostomy tube placement in patients with Loeys-Dietz syndrome

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