Pediatric gastrostomy tubes and techniques: making safer and cleaner choices.

Gastrostomy tube placement is a common procedure that can be accomplished with a variety of techniques, each with its attendant complications. In an effort to standardize practice at our institution, we retrospectively evaluated complications including early dislodgement requiring operative repair, leaks, and granulation tissue to determine the optimal technique. A retrospective cohort study (June 2008-July 2014) evaluating children (<18) receiving gastrostomy tubes was completed. We recorded demographic data, placement technique, and postoperative complications within 120 days. The seven techniques in use at our institution were categorized into three groups: standard pull-type techniques for percutaneous endoscopic gastrostomies (PEGs), "push" techniques using transabdominal sutures or T-fasteners for securement of the stomach, and "fascial" techniques using sutures directly from the stomach to the abdominal fascia at the stoma site. Descriptive statistics were analyzed using t test and Kruskal-Wallis tests as appropriate, and outcomes with P < 0.05 were considered significant. Of the 450 patients, 255 (56.7%) were male. Median age and weight at the time of operation were 19.3 months (interquartile range, 6.5-89.6 months) and 9.0 kg (interquartile range, 5.7-17.1 kg) respectively. By technique, 245 patients underwent fascial placement (54.4%), 112 underwent push (24.9 %), and 93 underwent PEG (20.7%). Push and fascial techniques were less likely become dislodged than PEG, with odds ratios (ORs) of 0.14 (confidence interval CI 0.02-0.66) and 0.31 (CI 0.11-0.83), respectively. Fascial techniques had more granulation tissue than either push or PEG pull methods, OR 2.39 (CI 1.20-3.36), and more leakage, OR 2.22 (CI 1.19-4.15). Dislodgement is most likely with PEG techniques. Granulation and leakage are most likely with fascial suture techniques. Push techniques are associated with the lowest complication rate.

Sutherland C ，Carr B ，Biddle KZ ，Jarboe M ，Gadepalli SK ... -  《-》

Comparing Outcomes Between "Pull" Versus "Push" Percutaneous Endoscopic Gastrostomy in Acute Care Surgery: Under-Reported Pull Percutaneous Endoscopic Gastrostomy Incidence of Tube Dislodgement.

Percutaneous endoscopic gastrostomy (PEG) complications are often under-reported in the literature, especially regarding the incidence of tube dislodgement (TD). TD can cause significant morbidity depending on its timing. We compared outcomes between "push" and "pull" PEGs. We hypothesized that push PEGs, because of its T-fasteners and balloon tip, would have a lower incidence of TD and complications compared with pull PEGs. We performed a chart review of our prospectively maintained acute care surgery database for patients who underwent PEG tube placement from July 1, 2009 through June 30, 2013. Data regarding age, gender, body mass index, indications (trauma versus nontrauma), and complications (including TD) were extracted. Procedure-related complications were classified as either major if patients required an operative intervention or minor if they did not. We compared outcomes between pull PEG and push PEG. Multiple regression analysis was performed to identify risk factors associated with major complications. During the 4-y study period, 264 patients underwent pull PEGs and 59 underwent push PEGs. Age, gender, body mass index, and indications were similar between the two groups. The overall complications (major and minor) were similar (20% pull versus 22% push, P = 0.61). The incidence of TD was also similar (12% pull versus 9% push, P = 0.49). However, TD associated with major complications was higher in pull PEGs but was not statistically significant (6% pull versus 2% push, P = 0.21). Multiple regression analysis showed that dislodged pull PEG was associated with major complications (odds ratio 29.5; 95% confidence interval, 11.3-76.9; P < 0.001). The incidence of pull PEG TD associated with major complications is under-recognized. Specific measures should be undertaken to help prevent pull PEG TD. IV, therapeutic.

Kulvatunyou N ，Zimmerman SA ，Sadoun M ，Joseph BA ，Friese RS ，Gries LM ，O'Keeffe T ，Tang AL ... -  《-》

Percutaneous endoscopic gastrostomy with T-bar fixation in children and infants.

Terry NE ，Boswell WC ，Carney DE ，Beck A ，Lowe L ，Rittmeyer C ... -  《-》

Alternative techniques of feeding gastrostomy in children: a critical analysis.

Goretsky MF ，Johnson N ，Farrell M ，Ziegler MM ... -  《JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS》

Percutaneous endoscopic gastrostomy: indications, technique, complications and management.

Rahnemai-Azar AA ，Rahnemaiazar AA ，Naghshizadian R ，Kurtz A ，Farkas DT ... -  《-》