Endoscopic vs laparoscopic paediatric gastrostomies: Time to change our practice?

Area of Science:

• Pediatric Surgery
• Minimally Invasive Procedures
• Gastroenterology

Background:

• Percutaneous endoscopic gastrostomy (PEG) is a common, rapid pediatric gastrostomy procedure.
• Emerging evidence suggests laparoscopic balloon gastrostomy (LBG) may offer reduced complication rates.
• Comparative safety and healthcare resource utilization of PEG versus LBG require investigation.

Purpose of the Study:

• To compare the safety of primary PEG versus LBG in pediatric patients.
• To evaluate the healthcare resource burden associated with PEG and LBG procedures.
• To determine the optimal first-line gastrostomy insertion method for children.

Main Methods:

• Retrospective review of pediatric gastrostomy insertions from 2011-2019.
• Primary outcomes included return to theatre for emergency laparotomy.
• Secondary outcomes assessed gastrostomy-related admissions, length of stay, and theatre utilization.

Main Results:

• 338 PEGs and 277 LBGs were analyzed with a minimum six-month follow-up.
• Emergency laparotomy for complications occurred in 3.6% of PEG cases versus 0.7% of LBG cases (p < 0.0267).
• No significant difference in total theatre utilization; however, PEG had a longer length of stay (4 vs 3 days).

Conclusions:

• Laparoscopic balloon gastrostomy (LBG) demonstrates a significantly lower rate of major complications compared to PEG.
• LBG insertion is not associated with an increased healthcare resource burden.
• LBG should be considered the preferred first-line method for pediatric gastrostomy.