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Complications of one-step button percutaneous endoscopic gastrostomy in children
Charlotte Jean-Bart C1,2, Madeleine Aumar3, Delphine Ley3
1Department of Pediatric Gastroenterology, Hepatology, and Nutrition, CHU Lille, INSERM 1286, University of Lille, Lille, 59000, France. charlotte.jean-bart@ch-roubaix.fr.
Insights
One-step button percutaneous endoscopic gastrostomy (B-PEG) is a safe pediatric procedure with low infection rates. However, T-fastener complications are common, especially in young or premature infants, necessitating careful monitoring.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Surgery
Background:
- Percutaneous endoscopic gastrostomy (PEG) is vital for pediatric enteral nutrition.
- The one-step button PEG (B-PEG) offers an alternative to traditional pull-PEG methods.
- Limited data exists on B-PEG specific complications and risk factors in children.
Purpose of the Study:
- To evaluate complications associated with B-PEG in pediatric patients.
- To identify risk factors for stomal infections and gastropexy issues.
- To compare B-PEG safety and efficacy with other PEG methods.
Main Methods:
- Retrospective analysis of 679 pediatric B-PEG procedures over 10 years.
- Data collection on patient demographics, early/late complications, and outcomes.
- Statistical analysis to determine risk factors for specific complications.
Main Results:
- Major complications were rare (<2%), with no B-PEG related deaths.
- Granulation tissue, tube dislodgement, and T-fastener issues were most frequent.
- Younger age increased peristomal infection risk (OR 2.34); neurological disease was protective for T-fastener migration (OR 0.59).
Conclusions:
- B-PEG demonstrates a low rate of local infection and is a safe procedure for children.
- T-fastener complications represent significant morbidity and require vigilance, particularly in vulnerable infants.
- B-PEG may offer advantages over P-PEG regarding major complication rates in pediatric populations.
Abstract:
To assess the complications of one-step button percutaneous endoscopic gastrostomy (B-PEG) and determine risk factors for developing stomal infections or gastropexy complications. A retrospective study of 679 children who underwent a B-PEG procedure in a single tertiary care center over a 10-year period to December 2020 was conducted. Patient characteristics, early complications (occurring ≤ 7 days after the procedure), late complications (> 7 days after the procedure), and outcomes were collected from medical records. A list of potential risk factors, including age at procedure, prematurity, underlying neurological disease, and undernutrition, was determined a priori. At least 1 year of follow-up was available for 513 patients. Median follow-up duration was 2.8 years (interquartile range 1.0-4.9 years). Major complications were rare (< 2%), and no death was related to B-PEG. Early complications affected 15.9% of the study population, and 78.0% of children presented late complications. Development of granulation tissue was the most common complication followed in frequency by tube dislodgment and T-fastener complications. Only 24 patients (3.5%) presented stomal infections. Young age at the time of PEG placement (odds ratio (OR) 2.34 [1.03-5.30], p = .042) was a risk factor for developing peristomal infection. T-fastener migration occurred in 17.3% of children, and we found underlying neurological disease was a protective factor (OR 0.59 [0.37-0.92], p = .019). Conclusion: B-PEG is a safe method and associated with a low rate of local infection. However, T-fasteners are associated with significant morbidity and require particular attention in young and premature infants. What is Known: • Percutaneous endoscopic gastrostomy (PEG) is the preferred method to provide long-term enteral nutrition in children to prevent malnutrition. The Pull-PEG method is still the most commonly used with complications , such as stomal infection. Since its description, only a few studies have reported postoperative complications of one-step button PEG (B-PEG). What is New: • T-fastener complications were not rare, and underlying neurologic disease was a protective factor. A very low rate of stomal infection was described, and young age at the time of PEG placement was a risk factor. The B-PEG is a safe method with fewer major complications than P-PEG in children.