Page 25 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

inTRoDUCTion
A gastrostomy tube placement is a frequently performed procedure to benefit children with feeding difficulties. The majority of these children have a significant neurological impairment. 1 Less frequent indications are an inadequate caloric intake in children with chronic medical diseases, failure to thrive, oesophageal atresia, dysphagia, short bowel syndrome and malabsorption. 2-4
In 1980, Gauderer et al. 5 introduced percutaneous endoscopic gastrostomy (PEG) as an alternative to the conventional gastrostomy tube placement. Because of its endoscopic approach, this technique is minimally invasive and easy to perform. After the first report, PEG became popular and many authors published on the safety and effectiveness of the procedure. 6-10 Nowadays, many institutions have used PEG as standard treatment in children.
Pediatric surgeons, later on, introduced laparoscopic gastrostomy placement (LGP) as a safe and effective minimally invasive alternative to PEG. 11,12 Although both procedures are nowadays widely used, controversy remains on which type is the preferred procedure in the pediatric population.
The main reason for caregivers to eventually choose for a gastrostomy tube placement is an improvement of nutritional status and quality of life (QoL). 13 Improvement of nutritional status and QoL are depended on the efficacy of enteral feeding and postoperative adverse events. 14 Possible adverse events associated with a gastrostomy are gastroesophageal reflux (GER) 15 and complications requiring reinterventions, such as damage to adjacent organs, hypergranulation at the insertion and gastric content leakage at the gastrostomy site. 6
None of the studies comparing PEG and LGP were able to conclude which type of approach results in the best nutritional outcome and the lowest risk of developing adverse events. 16,17 The aim of this study was to determine which type of approach, either PEG or LGP, is best practice in children, through a systematic review and meta-analysis comparing success rates, efficacy of enteral feeding and postoperative adverse events.
MeTHoDs
search strategy
This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.19,20 PubMed (1960–2011),
Chapter 2
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