Comparing Outcomes Between PEG Placement and Surgical GT Placement

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K Tazi et al. JPGN Reports 4(2):p e316, May 2023. | DOI: 10.1097/PG9.0000000000000316. Open Access: Complications of Percutaneous and Surgical Gastrostomy Placements in Children: a Single-Centre Series.

In this retrospective single-center pediatric (n=124) study, the authors analyzed complications that occurred up to 1 year after placement. Key findings:

  • Fifty-nine patients (47.6%) underwent endoscopic placement, 59 (47.6%) surgical placement, and 6 (4.8%) laparoscopic-assisted percutaneous endoscopic gastrostomy. 
  • 29 (14.4%) major and 173 (85.6%) minor complications were reported
  • This study highlights at least 1 complication (regardless of severity) in 106 (85.5%) patients and reports a significantly lower complication rate in the PEG group (major and minor combined) compared to the surgical group (laparoscopy and laparotomy) (OR, 0.3; 95% CI, 0.07–0.9) (P = 0.001).
  • In the endoscopic group, patients with concomitant neurological disease had significantly more early complications (25.8 vs. 3.6%; OR, 9.1)
  • In the surgical group, patients with undernutrition had significantly more major complications (12.1% vs. 40%; OR, 4.7; 95% CI, 1.2–18; P = 0.01)

Discussion:

  • The authors note that although their results found fewer complications in the PEG group, other studies have reported lower complications in surgically-placed GTs. “Baker et al (4). report, like Sanderg et al (9)., an advantage of the laparoscopic technique compared to the endoscopy technique in terms of major complication (OR, 0.29; 95% CI, 0.17–0.51; P = 0.0001). Several other studies (9,20,21) show similar results.”
  • “Although a single prophylactic antibiotic therapy with cefazolin is systematically administered before each procedure, the rate of infectious complications remains high: 13 cases of abdominal wall abscess or cellulitis (6.4% of total complications) and 33 cases of minor infection (16.3% of total complications) requiring local treatment.”
  • The strengths of this study are an exhaustive collection of detailed data permitting a precise analysis of complications

My take: The majority of studies suggest that laparoscopic GT placement is safer, unlike this study. A more definitive answer would require a randomized prospective study with rigorously-collected data. Also, GT complications are common, ~85% in this study; thus, family education is important both before and after GT placement.

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