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Percutaneous Endoscopic Gastrostomy with T-Fasteners versus "Pull Technique": Analysis of Complications
Alejandra Castrillo1, Laura García-Martínez1, Ana Laín1
1Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain.
Insights
T-fasteners gastrostomy (T-PEG) offers a safer alternative to pull-technique gastrostomy (P-PEG), reducing sedation needs and severe complications. T-PEG is associated with fewer urgent interventions and dislodgments during replacement.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Procedures
- Surgical Techniques
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a common procedure for enteral feeding.
- The T-fasteners gastrostomy (T-PEG) technique has emerged as a popular alternative to the traditional pull-technique gastrostomy (P-PEG).
- Comparing complication rates between T-PEG and P-PEG is crucial for optimizing patient care.
Purpose of the Study:
- To compare the complication rates of T-PEG and P-PEG in pediatric patients.
- To evaluate differences in sedation requirements and adverse events associated with each technique.
- To assess the incidence of tube dislodgement and the need for urgent interventions.
Main Methods:
- A retrospective observational study was conducted on pediatric patients who underwent PEG placement.
- Patients were divided into two groups: P-PEG (standard Ponsky technique) and T-PEG (using T-fasteners).
- Complications, sedation use, and need for urgent interventions were recorded and compared between the groups.
Main Results:
- Overall complication rates were similar between P-PEG (24.2%) and T-PEG (21.0%).
- P-PEG required significantly more sedation for button replacement (97% vs. 2.6%) and was associated with more early tube dislodgements.
- P-PEG led to more complications requiring urgent endoscopy, laparotomy, or laparoscopy (18.6% vs. 6.6%).
Conclusions:
- T-PEG is associated with significantly less sedation required for gastrostomy replacement compared to P-PEG.
- P-PEG presents a higher risk of complications during the first button replacement and requires more urgent interventions.
- T-PEG appears to be a safer and more efficient method for gastrostomy placement in pediatric patients, reducing the need for invasive procedures.
Introduction:
The T-fasteners gastrostomy (T-PEG) has become increasingly popular over recent years as an alternative to the "pull-technique" gastrostomy (P-PEG). This study aimed to compare P-PEG and T-PEG complications.
Materials And Methods:
A retrospective observational study of pediatric patients who underwent percutaneous endoscopic gastrostomy (PEG) placement. P-PEG was performed using the standard Ponsky technique and was replaced after 6 months by a balloon gastrostomy under sedation. T-PEG was performed using three percutaneous T-fasteners (that allow a primary insertion of a balloon gastrostomy). The balloon was replaced by a new one after 6 months without sedation. Complications were recorded.
Results:
In total, 146 patients underwent PEG placement, 70 P-PEG and 76 T-PEG. The mean follow-up was 3.9 years (standard deviation = 9.6). Age, weight, and associated comorbidities were comparable (p > 0.05). The overall complications were 17 (24.2%) in the P-PEG group and 16 (21.0%) in the T-PEG group (p > 0.05). P-PEG was associated with more sedation for button replacement (97 vs. 2.6% [p < 0.05]). P-PEG was associated with more early tube dislodgement during the first replacement (7.2 vs. 1.4% [p = 0.092]). Two of the five dislodged gastrostomies in the P-PEG group underwent laparotomy due to peritonitis, whereas the only dislodged gastrostomy in the T-PEG group was solved endoscopically. Altogether, P-PEG was associated with more complications that required urgent endoscopy, laparotomy, or laparoscopy (18.6 vs. 6.6% [p < 0.05]).
Conclusions:
P-PEG was associated with more sedation, complications during first button replacement, and complications requiring urgent endoscopy, laparotomy, or laparoscopy compared with T-PEG.
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