title: Complicated PEG-to-skin level gastrostomy conversions: analysis of risk factors for tract disruption.
abstract: 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.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: R
authors.initials: R
authors.lastname: Romero
authors.forename: F L
authors.initials: FL
authors.lastname: Martinez
authors.forename: S Y
authors.initials: SY
authors.lastname: Robinson
authors.forename: K M
authors.initials: KM
authors.lastname: Sullivan
authors.forename: M H
authors.initials: MH
authors.lastname: Hart
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D009752:Nutritional Status; D011183:Postoperative Complications; D012086:Reoperation; D012307:Risk Factors; D012737:Sex Factors