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Complicated PEG-to-skin level gastrostomy conversions: analysis of risk factors for tract disruption
R Romero1, F L Martinez, S Y Robinson
1Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Conversions to skin-level gastrostomy tubes increased the risk of tract disruption by 4.8-fold, particularly with obturator-type devices. Fluoroscopic verification is recommended after these procedures to ensure proper placement and prevent complications.
Area of Science:
- Pediatric Gastroenterology
- Surgical Device Innovation
Background:
- Percutaneous endoscopic gastrostomy (PEG) tube dislodgements during conversion to skin-level devices are known but lack identified risk factors.
- This study aimed to identify risk factors for tract disruption in pediatric patients undergoing gastrostomy conversions.
Purpose of the Study:
- To identify specific risk factors associated with gastrostomy tract disruption during conversion to skin-level devices in a pediatric population.
- To describe the management strategies for complications arising from these conversions.
Main Methods:
- Retrospective review of medical records for pediatric patients who underwent gastrostomy conversions in 1994.
- Statistical analysis including two-tailed student's t-test and calculation of risk ratios with 95% confidence limits.
Main Results:
- Gastrostomy tract disruption occurred in 20% (6/30) of tube conversions.
- No significant differences were found in age, sex, diagnoses, nutritional status, tract maturity, or PEG tube type between complicated and uncomplicated cases.
- Use of an 18F obturator-type skin-level gastrostomy tube was associated with a 4.8-fold increased risk of gastric separation.
Conclusions:
- Obturator-type skin-level gastrostomy tubes are linked to a higher risk of tract disruption.
- Fluoroscopic confirmation of intragastric placement is advised following initial conversions to skin-level gastrostomy tubes to mitigate risks.
Background:
PEG disruptions during conversions to skin-level gastrostomy devices have been described, but specific risk factors have not been reported. In this study, possible risk factors for tract disruption in a pediatric population were identified, and management of complications described.
Methods:
The medical records of patients who underwent gastrostomy conversions during 1994 were reviewed. Statistical analysis was performed using two-tailed student's t test, and risk ratios with 95% confidence limits were calculated.
Results:
Gastrostomy tract disruption occurred in 6 to 30 (20%) of tube conversions. Complicated and uncomplicated cases did not differ with regard to age, sex, primary or associated diagnoses, pregastrostomy or postgastrostomy nutritional status, tract maturity, or percutaneous gastrostomy tube type. The use of an 18F obturator-type skin-level gastrostomy tube increased the risk for gastric separation 4.8-fold. Tract disruptions were managed by fluoroscopic gastrostomy tube replacement, repeat PEG, or exploratory laparotomy with open gastrostomy.
Conclusions:
The use of obturator-type skin-level gastrostomy tubes was associated with an increased risk of tract disruption. Fluoroscopic verification of intragastric placement is warranted after initial conversions to skin-level gastrostomy tubes.