title: Percutaneous endoscopic gastrostomy with T-bar fixation in children and infants.
abstract: BACKGROUND
  The standard for placement of pediatric gastrostomy tubes has been percutaneous endoscopic gastrostomy (PEG) using the Ponsky "pull" technique. This study evaluated the safety and efficacy of PEG placement using the "push" technique with T-bar fixation in pediatric patients. This technique generally is limited to the adult population. With this technique, endoscopy is performed. The stomach is insufflated, and the anterior abdominal wall is transilluminated. T-bar fasteners are sequentially deployed to secure the stomach to the anterior abdominal wall. Using a modified Seldinger technique, a gastrostomy tube is placed through the center of the T-bars.
  
  
  METHODS
  A retrospective review of all PEG tubes placed in pediatric patients from 1997 to 2003 using the T-bar gastroscopy "push" technique was conducted. Patients 18 years of age or younger were included in the study. Data collected included patient age, operative time, procedure location, and complications.
  
  
  RESULTS
  The procedure was performed for 47 children (mean age, 6.4 years), including 15 infants younger than 1 year. The indications for long-term enteral access included failure to thrive (n = 11), feeding disorder secondary to neurologic dysfunction (n = 31), gastroparesis (n = 1), and dysphagia (n = 4). The operative time averaged 23 min (range, 12-45 min). One major complication occurred (gastrocolonic fistula). The one minor complication was early dislodgement of the gastrostomy tube, which required replacement.
  
  
  CONCLUSIONS
  This study found the described technique to be safe and effective for the placement of gastrostomy tubes in infants and children.
authors.affiliation: Department of Surgery, Memorial Health University Medical Center, 4700 Waters Avenue, Suite 511, Savannah, GA 31404, USA.
authors.forename: N E
authors.initials: NE
authors.lastname: Terry
authors.forename: W C
authors.initials: WC
authors.lastname: Boswell
authors.forename: D E
authors.initials: DE
authors.lastname: Carney
authors.forename: A
authors.initials: A
authors.lastname: Beck
authors.forename: L
authors.initials: L
authors.lastname: Lowe
authors.forename: C
authors.initials: C
authors.lastname: Rittmeyer
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D020776:Endoscopes, Gastrointestinal; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013536:Suture Techniques; D016896:Treatment Outcome