Variability in the Method of Gastrostomy Placement in Children

Abstract

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.

Advances and challenges of gastrostomy insertion in children

“…Although gastrostomy insertion has become a common procedure in children, the best method of placement still needs to be determined. The method of placement can vary significantly according to patient age, local expertise, and available healthcare facilities[ 53 ]. Therefore, more research is still needed including the best insertion technique for individual patient groups, the timing and type of best enteral feeds to be initiated after placement, and identifying specific risk factors for the development of complications.…”

Nationwide Survey for Pediatric Gastrostomy Tube Placement in Korea

“…However, fundoplication or gastrostomy using laparoscopy cannot shorten the procedure time or eliminate the need for general anesthesia, although a recent study reported that laparoscopic PEG may be safer than conventional PEG in high-risk pediatric patients with severe thoracoabdominal deformity, previous abdominal surgery, ventriculoperitoneal shunt, and abdominal tumors. 14 15 In addition, the difference in the procedures time depends more on the ability of the operator than on the procedure method. In this study, among the cases in which gastrostomy was performed again, there was a case in which the stormy site was placed too close to the pylorus, causing ballooning to interfere with gastric emptying.…”

Percutaneous Endoscopic Gastrostomy Tubes Can Be Considered Safe in Children: A Single-Center 11-Year Retrospective Analysis

“…The gastrostomies can be placed using laparoscopic or percutaneous approaches and it is not yet clear which of the used techniques is most effective and safest in children [10]. There are three different techniques for PEG placement, the per oral pull technique, the per oral push technique and direct percutaneous technique [11].…”