Related Experiment Videos
Morbidity in neurologically impaired children after percutaneous endoscopic versus Stamm gastrostomy
B H Cameron1, G K Blair, J J Murphy
1Department of General Pediatric Surgery, British Columbia Children's Hospital, Vancouver, Canada.
Insights
Percutaneous endoscopic gastrostomy (PEG) is safer than Stamm gastrostomy for neurologically impaired children. PEG reduces major complications and the need for anti-reflux surgery, making it the recommended initial procedure.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neurology
Background:
- Neurologically impaired children often need feeding gastrostomies.
- Limited data exists comparing endoscopic versus operative Stamm gastrostomy outcomes in this population.
- Symptomatic gastroesophageal reflux is a concern after gastrostomy placement.
Purpose of the Study:
- To compare postoperative complications and symptomatic gastroesophageal reflux between percutaneous endoscopic gastrostomy (PEG) and Stamm gastrostomy.
- To evaluate the need for fundoplication after each procedure.
- To recommend the optimal gastrostomy method for neurologically impaired children.
Main Methods:
- Retrospective study of 63 neurologically impaired children.
- Comparison between 30 children with PEG and 33 with Stamm gastrostomy.
- Average follow-up of 23 months.
Main Results:
- No significant difference in symptomatic gastroesophageal reflux between groups initially.
- Minor complications occurred in 30% of patients.
- All three major complications, including two deaths, occurred after Stamm gastrostomy.
- Symptomatic gastroesophageal reflux developed in 60% overall.
- Fundoplication rates were 10% after PEG versus 39% after Stamm gastrostomy (p < .025).
Conclusions:
- Percutaneous endoscopic gastrostomy is associated with lower morbidity compared to Stamm gastrostomy in neurologically impaired children.
- PEG significantly reduces the need for subsequent fundoplication for reflux.
- PEG is recommended as the preferred initial gastrostomy procedure for this patient group.
Abstract:
Neurologically impaired children frequently require a feeding gastrostomy. Few reports are available comparing the incidence of postoperative complications and symptomatic gastroesophageal reflux after endoscopic versus operative Stamm gastrostomy in this group of children. We undertook a retrospective study of 63 consecutive neurologically impaired children requiring a feeding gastrostomy, with an average of 23 months of follow-up. No child had symptomatic gastroesophageal reflux. Thirty children had a percutaneous endoscopic gastrostomy and 33 had a Stamm gastrostomy, depending on the preference of the surgeon. The two groups were comparable in age range, cause of neurologic impairment, and indication for gastrostomy. Minor complications occurred in 30%. All three major complications occurred after Stamm gastrostomy, including two postoperative deaths. Symptomatic gastroesophageal reflux developed in 60%. The incidence of fundoplication after gastrostomy was 10% in the percutaneous endoscopic gastrostomy group and 39% after Stamm gastrostomy (p < .025). Morbidity was lower after percutaneous endoscopic gastrostomy than after Stamm gastrostomy in this group of neurologically impaired children. Fundoplication for symptomatic gastroesophageal reflux was infrequent after percutaneous endoscopic gastrostomy and significantly more common after Stamm gastrostomy. Percutaneous endoscopic gastrostomy is recommended as the initial procedure in neurologically impaired children without symptomatic gastroesophageal reflux who require a feeding gastrostomy.