Reduced complication rate after implementation of a detailed treatment protocol for percutaneous endoscopic gastrostomy with T-fastener fixation in pediatric patients: A prospective study

Dahlseng, Magnus Odin; Skari, Hans; Perminow, Gøri; Kvello, Morten; Nyenget, Tove; Schistad, Ole; Stensrud, Kjetil Juul; Björnland, Kristin; Knatten, Charlotte Kristensen

doi:10.1016/j.jpedsurg.2022.03.025

Cited by 6 publications

(12 citation statements)

References 10 publications

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“…The present study shows that 16.6% of our population still experienced tube dislodgment before the rst change, suggesting that 3-4 months is a reasonable time for the rst replacement. In the present study population, only 1.0% experienced early tube dislodgment during the rst 7 days, consistent with ndings by Dahlseng et al (15).…”

Section: Discussionsupporting

confidence: 93%

“…Some investigators, such as Göthber et al, removed the suture lock systematically 2-3 weeks after the procedure to prevent Tfastener complications (11), but this measure has not been fully evaluated. Dhalseng et al decided to cut the sutures 2 weeks after the procedure, and the rate of T-fastener complications decreased signi cantly from 13% to 1% (15). We caution against an early cut of the suture because the gastrostomy tract needs time to be xed, and a lack of gastropexy may increase the risk of intraperitoneal migration of the button in the rst days after B-PEG placement, as we have observed in 1 patient.…”

Section: Discussionmentioning

confidence: 75%

“…This technique was immediately acceptable to children and their families. Only a few studies have reported postoperative complications of B-PEG in children, which seem to occur with a similar frequency to those of P-PEG (9)(10)(11)(12)(13)(14)(15). A previous study from our group comparing the frequency of complications in P-PEG and B-PEG found an associated marked reduction of stomal infection (29.0% and 10.6%, respectively) (9).…”

Section: Introductionmentioning

confidence: 73%

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Complications of one-step button percutaneous endoscopic gastrostomy in children

Aumar²,

Ley³

et al. 2023

Eur J Pediatr

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To assess the complications of one-step button percutaneous endoscopic gastrostomy (B-PEG) and determine risk factors for developing stomal infections or gastropexy complications. MethodsA retrospective study of 679 children who underwent a B-PEG procedure in a single tertiary care center over a 10-year period to December 2020 was conducted. Patient characteristics, early complications (occurring ≤7 days after the procedure), late complications (> 7 days after the procedure), and outcomes were collected from medical records. A list of potential risk factors, including age at procedure, prematurity, underlying neurological disease, and undernutrition, was determined a priori. ResultsAt least 1 year of follow-up was available for 513 patients. Median follow-up duration was 2.8 years (interquartile range 1.0-4.9 years). Major complications were rare (< 2%), and no death was related to B-PEG. Early complications affected 15.9% of the study population, and 78.0% of children presented late complications. Development of granulation tissue was the most common complication followed in frequency by tube dislodgment and T-fastener complications. Only 24 patients (3.5%) presented stomal infections. Young age at the time of PEG placement (odds ratio (OR) 2.34 [1.03-5.30], p = .042) was a risk factor for developing peristomal infection. T-fastener migration occurred in 17.3% of children, and we found underlying neurological disease was a protective factor (OR 0.59 [0.37-0.92], p = .019). ConclusionB-PEG is a safe method and associated with a low rate of local infection. However, T-fasteners are associated with signi cant morbidity and require particular attention in young and premature infants. What Is KnownPercutaneous endoscopic gastrostomy (PEG) is the preferred method to provide long-term enteral nutrition in children to prevent malnutrition. The Pull-PEG method is still the most commonly used with complications , such as stomal infection. Since its description, only a few studies have reported postoperative complications of one-step button PEG (B-PEG).

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 73%

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Complications of one-step button percutaneous endoscopic gastrostomy in children

Aumar²,

Ley³

et al. 2023

Eur J Pediatr

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“…Our results provide an additional justification for support. As discussed by Dahlseng et al , 10 the push technique is safe, and according to our observations, it takes only 15 min to be performed by experienced pediatric surgeons. The rate of T-fastener-related complications is significant and clearly a disadvantage of the technique.…”

Section: Discussionsupporting

confidence: 69%

“… 8 10 20 We share the same clinical experience that optimal tightness and duration of the T-fasteners seem to decrease the complications. 10 In our department, the percutaneous and endoscopic push technique remains the primary method for gastrostomy placement, and laparoscopy is reserved for cases in which safety of this method is in doubt during the procedure.…”

Section: Discussionmentioning

confidence: 99%

Complications after pediatric percutaneous endoscopic gastrostomy: comparison of the push and pull technique

Takalo,

Iber,

Autio

et al. 2024

World Jnl Ped Surgery

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PurposeVarious complications are associated with percutaneous endoscopic gastrostomy (PEG) procedures in children. The push technique is being increasingly used, but its complications are insufficiently characterized. We aimed to assess all complications related to PEG procedures and compare the safety of the pull and push techniques.MethodsRetrospective review of consecutive pediatric patients who underwent PEG between 2002 and 2020.ResultsIn total, 216 children underwent 217 PEG procedures. The push technique was used in 138 (64%) cases, and the pull technique in 79 (36%) cases. The median follow-up time was 6.1 (0.1–18.3) years. The complication rate was high (57%) and patients experienced complications years after the procedure. Overall, 51% and 67% of patients experienced complications in the push and pull groups, respectively. The rates of minor and major complications were higher in the pull group than in the push group (63% vs 48%,p=0.028; and 11% vs 6%,p=0.140, respectively). Reoperation was also more common in the pull group (17% vs 7%,p=0.020).ConclusionsThe overall complication rate of PEG procedures is high. Fortunately, most complications are mild and do not require reoperations. The increasing push technique appears to be safer than the traditional pull technique. Significant long-term morbidity is related to gastrostomies in children.

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Push-PEG or Pull-PEG: Does the Technique Matter? A Prospective Study Comparing Outcomes After Gastrostomy Placement

Knatten,

Dahlseng,

Perminow

et al. 2024

Journal of Pediatric Surgery

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Reduced complication rate after implementation of a detailed treatment protocol for percutaneous endoscopic gastrostomy with T-fastener fixation in pediatric patients: A prospective study

Cited by 6 publications

References 10 publications

Complications of one-step button percutaneous endoscopic gastrostomy in children

Complications of one-step button percutaneous endoscopic gastrostomy in children

Complications after pediatric percutaneous endoscopic gastrostomy: comparison of the push and pull technique

Push-PEG or Pull-PEG: Does the Technique Matter? A Prospective Study Comparing Outcomes After Gastrostomy Placement

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