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Modification of the "push" technique for percutaneous endoscopic gastrostomy in infants and children
F M Robertson1, T M Crombleholme, L A Latchaw
1Division of Pediatric Surgery, Department of Surgery, Tufts University School of Medicine, Boston, MA USA.
Insights
A modified "push" technique for percutaneous endoscopic gastrostomy (PEG) insertion effectively prevents gastric insufflation loss in infants. This safe and simple method avoids risks associated with the "pull" technique for pediatric PEG placement.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Procedures
- Endoscopic Surgery
Background:
- The "push" technique for percutaneous endoscopic gastrostomy (PEG) insertion offers advantages over the "pull" technique, including reduced infection risk and fewer endoscopic interventions.
- However, the "push" technique can lead to gastric insufflation and pneumoperitoneum during tract dilation, particularly in small infants.
- A novel modification to the "push" technique has successfully addressed these limitations.
Purpose of the Study:
- To evaluate the safety and efficacy of a modified "push" technique for percutaneous endoscopic gastrostomy (PEG) insertion in infants and children.
- To assess the incidence of complications, particularly loss of gastric insufflation, associated with the modified technique.
- To compare the benefits of the modified "push" technique against the traditional "pull" technique in the pediatric population.
Main Methods:
- A retrospective review of 22 infants and children who underwent PEG insertion using the modified "push" technique over a 16-month period.
- Data collected included patient demographics, indications for PEG, procedure duration, cost, and complications.
- Follow-up examinations were conducted for patients ranging from nine to 30 months post-procedure.
Main Results:
- The modified "push" technique was successfully used in 20 out of 22 pediatric patients (95%), with an average procedure time of 15 minutes.
- Indications included failure to thrive due to cystic fibrosis and neurologic impairment.
- No deaths or peri-catheter infections were reported; the single failure was due to loss of gastric insufflation when Fogarty balloons failed.
Conclusions:
- A simple modification to the "push" technique effectively resolves issues of gastric insufflation loss in infants undergoing PEG insertion.
- The modified "push" technique is a safe, simple, and rapid procedure for pediatric PEG placement.
- This method mitigates the potential risks associated with the "pull" technique in infants.
Background:
Percutaneous endoscopic gastrostomy (PEG) by the "push" technique avoids peri-catheter infection, repeated insertion of the endoscope, potential esophageal injury from the catheter, and the possible need for another endoscopy for catheter removal associated with the "pull" technique. In small infants, however, the "push" technique could result in loss of gastric insufflation and pneumoperitoneum during tract dilatation. A simple modification of the "push" technique has eliminated this problem.
Study Design:
During a 16-month period, 22 infants and children underwent PEG insertion using our modified "push" technique. These cases were reviewed for patient characteristics including age, weight, indication for the procedure, duration of the procedure, cost, conversion to open technique, and complications.
Results:
We have used the modified "push" technique to place PEG tubes in 20 infants and children aged four weeks to 15 years (mean, 13 months), weighing 2.7 to 36 kg (median, 6.0 kg), indicated for failure to thrive due to cystic fibrosis (n=3) or neurologic impairment (n=10). These patients have had follow-up examination from nine to 30 months after the procedure. Operative time averaged 15 minutes. The "push" technique was successful in 95 percent of patients with one failure caused by loss of gastric insufflation when Fogarty balloons failed. All PEGs were used within 24 hours. There were no deaths and no peri-catheter infections.
Conclusions:
A simple modification of the "push" technique of PEG insertion eliminated problems with loss of gastric insufflation previously encountered in small infants. The modified "push" technique is safe, simple, and quick, obviating potential risks inherent in the "pull" technique when applied in infants.