Page 26 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

EMBASE (1980–2011) and the Cochrane Library (December 2012, issue 6) were systematically searched using predefined search terms to identify all articles comparing PEG to LGP. For PubMed, the following search terms were used: (Paediatrics[Mesh] OR child[MeSH] OR child*[tiab] OR infant*[tiab] OR adolescent*[tiab] OR paediatric*[tiab] OR paediatric*[tiab]) AND (Gastrostoma*[tiab] OR ‘gastric feeding tube’[tiab] OR gastrostomy[MeSH]). The same search strategy was used in EMBASE (replacing ‘[Title/ Abstract]’ with ‘ti, ab’ and ‘[MeSH Terms]’ with ‘/exp’). Human, child and adolescent were used as search limits in both databases. Language restrictions and time horizons were not applied.
study selection criteria
Each article was independently assessed for eligibility using the following predefined criteria:
– Study design: Originally published articles.
– Study population: Infants and children (0–18 years) who underwent gastrostomy
placement.
– Intervention: Documented surgical technique.
– Study outcomes: At least one of the outcomes of interest reported below.
Studies were excluded from analysis if the authors performed concomitant antireflux procedures or if primary outcome parameters were not reported. In case of multiple studies reporting on the same study population, only the study with the largest patient population was included.
outcomes of interest
Primary outcomes of interest were (1) success rates of GP, defined as either completion rate or conversion rate of the procedure, time to first feeding and time to reaching full feedings after operation; (2) efficacy of feeding, defined by the method of feeding and the effects of gastrostomy placement on nutritional status (body mass index, weight-for-height and height-for-age z-scores); 18 (3) QoL, either described or quantified with a validated QoL questionnaire (4) GER, assessed by descriptive symptoms or standardized GER questionnaires and/or 24-hour pH monitoring (with or without multichannel intraluminal impedance) and/or the need for postoperative antireflux surgery; and (5) complications associated with gastrostomy placement (e.g. adjacent bowel injury, early tube dislodgement, intraperitoneal leakage both before and after gastrostomy tube exchange, nonclosure of the gastrostomy after removal of the catheter) and overall rates of complications requiring reintervention under general anaesthesia.
Secondary outcomes of interest were minor complications (e.g. gastric content leakage at the gastrostomy site, infection or hypergranulation of the gastrostomy insertion), operating time, duration of hospital admission and hospital and procedural costs.
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