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Published on: February 28, 2025
A systematic review and meta-analysis of gastrostomy insertion techniques in children
Laura Baker1, Alana L Beres2, Robert Baird2
1McGill University, Montreal, Quebec, Canada.
Insights
Laparoscopic gastrostomy insertion is safer than percutaneous endoscopic gastrostomy (PEG) in children, with fewer major complications. This finding suggests prioritizing laparoscopic methods for improved patient safety in pediatric enteral feeding.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Device Technology
Background:
- Gastrostomy tubes are crucial for pediatric enteral feeding.
- Multiple insertion techniques exist, each with varying complication rates.
- Resource utilization is a key consideration in pediatric gastrostomy placement.
Purpose of the Study:
- To compare major complication rates of pediatric gastrostomy insertion techniques.
- To evaluate resource utilization across different gastrostomy methods.
- To identify the safest and most effective gastrostomy approach for children.
Main Methods:
- Systematic review and meta-analysis of comparative studies.
- Inclusion of open, laparoscopic, percutaneous endoscopic, and fluoroscopic guided techniques.
- Definition of major complications as reoperation within 1 year or death.
Main Results:
- Twenty-two studies involving 5438 pediatric patients were analyzed.
- No significant difference in major complications between open and laparoscopic gastrostomy.
- Percutaneous endoscopic gastrostomy (PEG) showed a significantly higher risk of major complications compared to laparoscopic gastrostomy (OR 0.29, p<0.0001).
Conclusions:
- Percutaneous endoscopic gastrostomy (PEG) is associated with increased major complications in pediatric patients compared to the laparoscopic approach.
- The enhanced safety profile of laparoscopic gastrostomy insertion outweighs potential advantages in operative time.
- Laparoscopic gastrostomy is recommended for improved safety in pediatric enteral feeding.
Background:
Gastrostomy tubes are inserted via multiple techniques to provide a route for enteral feeding in the pediatric population. This review compares the rate of major complications and resource utilization associated with the various insertion techniques.
Methods:
Major electronic databases were queried for comparative studies of two or more insertion techniques, including open, laparoscopic, percutaneous endoscopic, or fluoroscopic guided. Major complications were defined as reoperation within 1 year or death. Screening of eligible studies, data extraction, and assessment of methodological quality were conducted independently by two reviewers. Forest and funnel plots were generated for outcomes using Revman 5.1, with p<0.05 considered significant.
Results:
Twenty-two studies with a total of 5438 patients met inclusion criteria. No differences in major complications were noted in studies comparing open versus laparoscopic approaches or open versus PEG. Studies comparing laparoscopic gastrostomy and PEG revealed a significantly increased risk in major complications with PEG (n=10 studies, OR 0.29, 95% CI: 0.17-0.51, p<0.0001). The number needed to treat to reduce one major complication by abandoning PEG is 45.
Conclusions:
PEG is associated with an increased risk of major complications when compared to the laparoscopic approach. Advantages in operative time appear outweighed by the increased safety profile of laparoscopic gastrostomy insertion.
