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Abdominal plain film before gastrostomy tube placement to predict success of percutaneous endoscopic procedure

J M Pruijsen1, A de Bruin, G Sekema

  • 1Department of Pediatric Gastroenterology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Journal of Pediatric Gastroenterology and Nutrition
|August 28, 2012
PubMed

Insights

Abdominal X-rays before percutaneous endoscopic gastrostomy (PEG) placement can predict insertion failure in children with specific conditions. This imaging helps avoid repeat anesthesia by identifying high-risk patients needing alternative surgical approaches.

Area of Science:

  • Pediatric Gastroenterology
  • Medical Imaging
  • Surgical Planning

Background:

  • Percutaneous endoscopic gastrostomy (PEG) is vital for pediatric long-term enteral nutrition.
  • Many pediatric PEG candidates have high American Society of Anesthesiologists (ASA) physical status (≥ III), increasing perioperative risks.
  • Anatomical variations can cause PEG insertion failure, necessitating repeat anesthesia and potentially surgical gastrostomy.

Purpose of the Study:

  • To evaluate the effectiveness of preoperative abdominal plain film with gastric insufflation in predicting successful PEG insertion in pediatric patients.
  • To identify factors contributing to PEG insertion failure and optimize procedural planning.

Main Methods:

  • A single-center cohort study involving 303 pediatric PEG candidates.
  • Abdominal plain film with gastric insufflation was performed pre-procedure.
  • Success was defined by successful PEG tube insertion; multivariate logistic regression identified failure predictors.

Main Results:

  • Overall PEG insertion success rate was 95% (287/303).
  • Abnormal abdominal films significantly reduced success probability to 67%.
  • Key predictors of PEG insertion failure included spinal deformities (OR 12.1), prior abdominal surgery (OR 8.5), neurological impairment (OR 4.1), and abnormal plain films (OR 10.3).

Conclusions:

  • Preoperative abdominal radiography can identify pediatric PEG candidates at high risk for insertion failure, particularly those with spinal deformities, previous abdominal surgery, or neurological impairment.
  • This imaging strategy allows for proactive surgical consultation and planning, potentially avoiding repeat anesthesia and optimizing patient care.
  • Early identification of potential PEG failure through imaging facilitates informed decision-making and resource allocation.
Abstract

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