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Percutaneous endoscopic gastrostomy with T-bar fixation in children
W C Boswell1, C R Boyd, S A Lord
1Department of Surgical Education, Memorial Medical Center, Savannah, Georgia 31403-2084, USA.
Insights
The "push" technique for pediatric percutaneous endoscopic gastrostomy (PEG) with T-bar fixation is safe and effective. This method offers a viable alternative for gastrostomy tube placement in children.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Surgery
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a common procedure for pediatric enteral feeding.
- The Ponsky
- pull
- technique has been the standard for PEG placement in children since 1979.
Purpose of the Study:
- To evaluate the safety and efficacy of the
- push
- technique for PEG with T-bar fixation in pediatric patients.
Main Methods:
- Retrospective review of PEGs performed in pediatric patients (≤17 years) over 31 months.
- Exclusion of patients with prior abdominal surgery.
- Detailed evaluation of age, indications, procedure time, and complications.
Main Results:
- Fifteen pediatric patients (mean age, 9 years) underwent the procedure.
- Indications included need for long-term enteral alimentation, progressive neurologic dysfunction, and failure to thrive.
- No significant major postoperative complications were observed.
Conclusions:
- The
- push
- technique with T-bar fixation is a safe and effective method for pediatric gastrostomy.
- This technique provides a valuable alternative for gastrostomy tube placement in children.
Abstract:
Percutaneous endoscopic gastrostomy (PEG) with the Ponsky "pull" technique has been the standard technique for pediatric gastrostomy tube placement since 1979. We evaluated safety and efficacy of PEG with the "push" technique and T-bar fixation. We reviewed PEGs performed in pediatric patients (< or = 17 years) over a 31-month period, excluding patients with previous abdominal surgery. We evaluated age, indications, location, time, and complications. Endoscopy was performed, the stomach insufflated, and the anterior abdominal wall transilluminated. T-bar fasteners were inserted percutaneously under endoscopic control. Fasteners were ejected from the needle tip with a stylet and secured. A 14 or 18 French gastrostomy tube was placed through the center of previously placed T-bar fasteners by using a modified Seldinger technique. Fifteen children (mean age, 9 years) underwent the procedure for the need for long-term enteral alimentation (severe closed head injury) (n = 7), for progressive neurologic dysfunction with feeding disorder (n = 7), or for failure to thrive (cystic fibrosis) (n = 1). No significant major postoperative complications occurred. The technique proved safe and effective for gastrostomy in children.