Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis

Suksamanapun, Nutnicha; Mauritz, Femke A.; Franken, Josephine; Zee, David C. van der; Herwaarden-Lindeboom, Maud Y. van

doi:10.4103/0972-9941.181776

Cited by 29 publications

(12 citation statements)

References 47 publications

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“…Another support of LAG prior PEG regarding complications has also been shown in a previous review of complications after gastrostomy placements [23] and a recent meta-analysis with fewer studies [24]. …”

Section: Discussionmentioning

confidence: 70%

“…In a previous meta-analysis on gastrostomy placement in children, using death or reoperations within the first postoperative year as the end points, Baker et al [ 2 ] have also found that the LAG technique was more favorable compared with the PEG technique, with a calculated OR of 0.29 and a 95% CI of 0.17–0.51 ( p = 0.0001), and 45 cases were needed for treatment to reduce one major complication by abandoning PEG placement. Another support of LAG prior PEG regarding complications has also been shown in a previous review of complications after gastrostomy placements [ 23 ] and a recent meta-analysis with fewer studies [ 24 ].…”

Section: Discussionmentioning

confidence: 70%

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

et al. 2018

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PurposeA meta-analysis was performed to compare the rates of the major complications associated with two gastrostomy tube placement techniques in a pediatric population: laparoscopy-assisted gastrostomy (LAG) and percutaneous endoscopic gastrostomy (PEG).MethodsThe PubMed electronic database was queried for comparative studies of the two insertion techniques. The Newcastle–Ottawa scale (NOS) was used for the assessment of the quality and risk of bias in the included studies. The main outcome measure was the frequency of major complications defined as the need for reoperation within 30 days or death. RevMan 5.3, was used, with a p < 0.05 indicating statistical significance.ResultsEight studies including 1550 patients met the inclusion criteria. The risk for major complications was higher in PEG than in LAG 3.86 (95% confidence interval 1.90–7.81; p < 0.0002). The number needed to treat to reduce one major complication by performing LAG instead of PEG was 23. There were no randomized-controlled trials. Overall, the quality of the included studies was determined to be unsatisfactory.ConclusionsPEG placement was associated with a significantly higher risk of major complications compared to LAG placement. Therefore, LAG should be the preferred method for gastrostomy tube placement in children.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 70%

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

et al. 2018

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“…The first review of 22 studies with a total of 5438 patients found a significantly increased risk of major complications with PEG compared to laparoscopic gastrostomy mostly due to a difference in visceral injury between the two techniques [3]. 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: 99%

“…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%

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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“…2 Similar results were reported in a heterogeneous group of patients. 3 However, PEG showed no differences in mortality or infection compared with percutaneous radiologic gastrostomy. 4 Complications are inherent with any procedure; awareness of immediate and late complications of PEG insertion is vital.…”

mentioning

confidence: 94%

Indolent complication after percutaneous endoscopic gastrostomy: a case report of gastric fistula

Gourishankar

2020

World Jnl Ped Surgery

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Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis

Cited by 29 publications

References 47 publications

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

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

Variability in the Method of Gastrostomy Placement in Children

Indolent complication after percutaneous endoscopic gastrostomy: a case report of gastric fistula

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