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One-Step Insertion of Low-Profile Gastrostomy in Pediatric Patients vs Pull Percutaneous Endoscopic Gastrostomy:
Gunnar Göthberg1, Sigge Björnsson2
1Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Göteborg, Sweden gunnar.gothberg@vgregion.se.
Insights
A new 1-step endoscopic button placement is a feasible alternative to pull percutaneous endoscopic gastrostomy (pull-PEG) for initiating enteral feeding in children. This method offers comparable outcomes with reduced anesthesia and operating room time.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Surgery
- Medical Device Technology
Background:
- Traditional pull percutaneous endoscopic gastrostomy (pull-PEG) is standard for pediatric enteral feeding.
- A novel 1-step endoscopic procedure for low-profile gastrostomy button placement has been developed.
- This study compares outcomes of the 1-step button placement versus pull-PEG in children.
Purpose of the Study:
- To evaluate the efficacy and safety of the 1-step gastrostomy button placement.
- To compare procedural metrics between the 1-step button and pull-PEG methods.
- To assess complication rates and stoma site health in pediatric patients.
Main Methods:
- Retrospective analysis of procedural data from 374 pediatric patients.
- Inclusion of patients aged 6 days to 16 years with diverse gastrostomy indications.
- Comparison of procedural time, time to first feeds, and stoma site complications between the two methods.
Main Results:
- Successful placement of the 1-step button in 98% of cases.
- Median procedural times: 20 minutes for button, 15 minutes for pull-PEG.
- Equivalent median times to first feeds (6 hours); nutrition feeds: 12.5 hours (button) vs. 10 hours (pull-PEG).
- Similar stoma site complication rates; healthy stoma proportions: 65.2% (button) vs. 73.2% (pull-PEG) at first follow-up.
Conclusions:
- The 1-step gastrostomy button procedure is a viable alternative to pull-PEG for initial tube placement in children.
- This method simplifies the procedure, reducing anesthesia and OR time.
- Comparable outcomes suggest the 1-step approach is a safe and effective option for pediatric enteral access.
Background:
Standard care for initiation of enteral feeding in children has been pull percutaneous endoscopic gastrostomy (pull-PEG). As an alternative to pull-PEG, a 1-step endoscopic procedure for inserting a low-profile gastrostomy tube "button" has been developed that allows initial placement of a balloon-retained device. This report presents outcomes of metrics used to compare button placement with pull-PEG in a pediatric population.
Methods:
Data were generated from procedural experiences of surgeons on pediatric patients (n = 374) with a variety of clinical indications for gastrostomy. Study population ages ranged from 6 days to 16 years, while weights were from 2-84 kg.
Results:
The button was successfully placed by the 1-step procedure in 98% of the respective study population, and median procedural times were 20 and 15 minutes for button and pull-PEG placements, respectively. Median times to first feeds were equivalent for the 1-step procedure and pull-PEG (6 hours), while times to first nutrition feeds were 12.5 and 10 hours, respectively. Stoma site complications within each study group were similar. Healthy stoma proportions were 65.2% and 73.2% in the 1-step procedure and pull-PEG groups, respectively, at first follow-up.
Conclusions:
Similar study outcomes between the 1-step procedure and pull-PEG groups suggest that the former is a feasible alternative to pull-PEG for initial tube placement in children. The 1-step method involves a single procedure and reduces patient exposure to anesthesia, operating room time, and the potential for complications compared with a pull-PEG requirement for multiple procedures.
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