title: Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) and laparoscopic-assisted gastrostomy (LAG) are widely used in the paediatric population. The aim of this study was to determine which one of the two procedures is the most effective and safe method.
  
  
  METHODS
  This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement. Primary outcomes were success rate, efficacy of feeding, quality of life, gastroesophageal reflux and post-operative complications.
  
  
  RESULTS
  Five retrospective studies, comparing 550 PEG to 483 LAG placements in children, were identified after screening 2347 articles. The completion rate was similar for both procedures. PEG was associated with significantly more adjacent bowel injuries (P = 0.047), early tube dislodgements (P = 0.02) and complications that require reintervention under general anaesthesia (P < 0.001). Minor complications were equally frequent after both procedures.
  
  
  CONCLUSIONS
  Because of the lack of well-designed studies, we have to be cautious in making definitive conclusions comparing PEG to LAG. To decide which type of gastrostomy placement is best practice in paediatric patients, randomised controlled trials comparing PEG to LAG are highly warranted.
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Nutnicha
authors.initials: N
authors.lastname: Suksamanapun
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Femke A
authors.initials: FA
authors.lastname: Mauritz
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Josephine
authors.initials: J
authors.lastname: Franken
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: David C
authors.initials: DC
authors.lastname: van der Zee
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
authors.forename: Maud Ya
authors.initials: MY
authors.lastname: van Herwaarden-Lindeboom