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Complications of one-step button percutaneous endoscopic gastrostomy in children

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Abstract

To assess the complications of one-step button percutaneous endoscopic gastrostomy (B-PEG) and determine risk factors for developing stomal infections or gastropexy complications. A retrospective study of 679 children who underwent a B-PEG procedure in a single tertiary care center over a 10-year period to December 2020 was conducted. Patient characteristics, early complications (occurring ≤ 7 days after the procedure), late complications (> 7 days after the procedure), and outcomes were collected from medical records. A list of potential risk factors, including age at procedure, prematurity, underlying neurological disease, and undernutrition, was determined a priori. At least 1 year of follow-up was available for 513 patients. Median follow-up duration was 2.8 years (interquartile range 1.0–4.9 years). Major complications were rare (< 2%), and no death was related to B-PEG. Early complications affected 15.9% of the study population, and 78.0% of children presented late complications. Development of granulation tissue was the most common complication followed in frequency by tube dislodgment and T-fastener complications. Only 24 patients (3.5%) presented stomal infections. Young age at the time of PEG placement (odds ratio (OR) 2.34 [1.03–5.30], p = .042) was a risk factor for developing peristomal infection. T-fastener migration occurred in 17.3% of children, and we found underlying neurological disease was a protective factor (OR 0.59 [0.37–0.92], p = .019).

  Conclusion: B-PEG is a safe method and associated with a low rate of local infection. However, T-fasteners are associated with significant morbidity and require particular attention in young and premature infants.

What is Known:

• Percutaneous endoscopic gastrostomy (PEG) is the preferred method to provide long-term enteral nutrition in children to prevent malnutrition. The Pull-PEG method is still the most commonly used with complications , such as stomal infection. Since its description, only a few studies have reported postoperative complications of one-step button PEG (B-PEG).

What is New:

• T-fastener complications were not rare, and underlying neurologic disease was a protective factor. A very low rate of stomal infection was described, and young age at the time of PEG placement was a risk factor. The B-PEG is a safe method with fewer major complications than P-PEG in children.

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Abbreviations

B-PEG:

One step button percutaneous endoscopic gastrostomy

CI :

Confidence interval

IQR:

Interquartile range

OR:

Odds ratio

PEG:

Percutaneous endoscopic gastrostomy

P-PEG:

Pull technique of percutaneous endoscopic gastrostomy

PPI:

Proton pump inhibitor

SD:

Standard deviation

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Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Hepatology, and Nutrition, CHU Lille, INSERM 1286, University of Lille, Lille, 59000, France

    Charlotte Jean-Bart C, Madeleine Aumar, Delphine Ley, Matthieu Antoine, Stéphanie Coopman, Dominique Guimber, Dominique Turck & Frédéric Gottrand

  2. Department of Pediatrics, Children’s Hospital, Roubaix, France

    Charlotte Jean-Bart C & Serge Ganga

  3. Department of Biostatistics, University of Lille, ULR 2694, Lille, France

    Emeline Cailliau

Authors
  1. Charlotte Jean-Bart C
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  2. Madeleine Aumar
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  3. Delphine Ley
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  4. Matthieu Antoine
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  5. Emeline Cailliau
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  6. Stéphanie Coopman
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  7. Dominique Guimber
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  8. Serge Ganga
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  9. Dominique Turck
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  10. Frédéric Gottrand
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Charlotte Jean-Bart, Frédéric Gottrand, and Emeline Cailliau. The first draft of the manuscript was written by Charlotte Jean-Bart, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Charlotte Jean-Bart C.

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Ethics approval and consent to participate

This is an observation study. The present research was conducted in accordance with protocols, good clinical practice, and the relevant laws and regulations in France. An information letter and an opposition form were completed by the patient’s parents or legal guardian. The study was declared to the French Data Protection Authority (Commission Nationale Informatique & Libertés). All data were anonymized.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter.

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Jean-Bart C, C., Aumar, M., Ley, D. et al. Complications of one-step button percutaneous endoscopic gastrostomy in children. Eur J Pediatr 182, 1665–1672 (2023). https://doi.org/10.1007/s00431-023-04822-7

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  • DOI: https://doi.org/10.1007/s00431-023-04822-7

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