title: Gastrostomy insertion in children: percutaneous endoscopic or percutaneous image-guided?
abstract: OBJECTIVE
  Gastrostomy insertion in children can be performed in many ways, but which is the best technique remains uncertain. This study evaluates the outcome of percutaneous endoscopic gastrostomy (PEG) and image-guided gastrostomy (IG).
  
  
  METHODS
  We reviewed children who had either PEG (n = 136) inserted by pediatric surgeons or IG (n = 195) inserted by interventional radiologists in our hospital between May 2004 and July 2008. Gastrostomy-related complications were given scores ranging from 20 for major complications (eg, peritonitis, gastrointestinal bleed, and visceral injury) to 1 for minor (eg, site infection and tube migration), and total score per month of follow-up was calculated per patient.
  
  
  RESULTS
  Conversion to laparoscopic or open gastrostomy was more frequent in PEG versus IG (P = .001). Fewer PEG patients (28%) had complications than did IG (47%) (P = .001). One PEG patient developed a gastrocolic fistula. In the IG group, 2 patients had transverse colon puncture, 1 had intraperitoneal tube detachment, and 1 had upper gastrointestinal bleeding. When scored and adjusted by length of follow-up, PEG had lower scores compared with IG, indicating a better outcome (P = .03). These findings were supported by zero-inflated Poisson regression analysis.
  
  
  CONCLUSIONS
  Major complications were rare and observed more frequently after IG. Minor complications were observed in both procedures but were significantly less common in PEG.
authors.affiliation: Department of General Surgery, Great Ormond Street Hospital, and the Institute of Child Health, London UK.
authors.forename: Shireen A
authors.initials: SA
authors.lastname: Nah
authors.forename: Bommayya
authors.initials: B
authors.lastname: Narayanaswamy
authors.forename: Simon
authors.initials: S
authors.lastname: Eaton
authors.forename: Paolo De
authors.initials: PD
authors.lastname: Coppi
authors.forename: Edward M
authors.initials: EM
authors.lastname: Kiely
authors.forename: Joe I
authors.initials: JI
authors.lastname: Curry
authors.forename: David P
authors.initials: DP
authors.lastname: Drake
authors.forename: Alex M
authors.initials: AM
authors.lastname: Barnacle
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roebuck
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies