CAPS Paper
A systematic review and meta-analysis of gastrostomy insertion techniques in children

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Abstract

Background

Gastrostomy tubes are inserted via multiple techniques to provide a route for enteral feeding in the pediatric population. This review compares the rate of major complications and resource utilization associated with the various insertion techniques.

Methods

Major electronic databases were queried for comparative studies of two or more insertion techniques, including open, laparoscopic, percutaneous endoscopic, or fluoroscopic guided. Major complications were defined as reoperation within 1 year or death. Screening of eligible studies, data extraction, and assessment of methodological quality were conducted independently by two reviewers. Forest and funnel plots were generated for outcomes using Revman 5.1, with p < 0.05 considered significant.

Results

Twenty-two studies with a total of 5438 patients met inclusion criteria. No differences in major complications were noted in studies comparing open versus laparoscopic approaches or open versus PEG. Studies comparing laparoscopic gastrostomy and PEG revealed a significantly increased risk in major complications with PEG (n = 10 studies, OR 0.29, 95% CI: 0.17–0.51, p < 0.0001). The number needed to treat to reduce one major complication by abandoning PEG is 45.

Conclusions

PEG is associated with an increased risk of major complications when compared to the laparoscopic approach. Advantages in operative time appear outweighed by the increased safety profile of laparoscopic gastrostomy insertion.

Section snippets

Guideline

The PRISMA statement, checklist and flowchart were referenced to achieve the highest standard in reporting items for a systematic review and meta-analysis [18], [19].

Literature search

A systematic search of electronic databases was performed to identify all relevant studies comparing two or more gastrostomy insertion techniques in children reporting procedural-related complication rates. A reference librarian was consulted to assist with the development of database-specific search strategies. We used exploded

Description of identified studies

The search strategy for the review resulted in 22 studies meeting inclusion criteria, with 5346 participants overall (Table 1) [3], [11], [15], [16], [17], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37]. The results of the search strategy are detailed in Fig. 1. Of the 22 studies identified, the median MINORS score of all studies was 14 (range 10–16), max = 24.

Three studies identified compared three or more techniques (Conlon et al. [16],

Discussion

Gastrostomy tube placement remains a highly popular intervention with a number of indications, in both adult and pediatric populations. Since initially introduced in 1986 as an open surgical approach, it has evolved into a procedure performed using multiple different techniques by several different operators, including surgeons, gastrointestinal endoscopists and interventional radiologists. Over the past 30 years, outcomes following gastrostomy tube placement have been extensively investigated,

Acknowledgements

We would like to thank Robin Featherstone from the McGill Faculty of Medicine Library for her assistance with the literature search and the retrieval of articles.

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