Abstract
Introduction The T-fasteners gastrostomy (T-PEG) has become increasingly popular over recent years
as an alternative to the “pull-technique” gastrostomy (P-PEG). This study aimed to
compare P-PEG and T-PEG complications.
Materials and Methods A retrospective observational study of pediatric patients who underwent percutaneous
endoscopic gastrostomy (PEG) placement. P-PEG was performed using the standard Ponsky
technique and was replaced after 6 months by a balloon gastrostomy under sedation.
T-PEG was performed using three percutaneous T-fasteners (that allow a primary insertion
of a balloon gastrostomy). The balloon was replaced by a new one after 6 months without
sedation. Complications were recorded.
Results In total, 146 patients underwent PEG placement, 70 P-PEG and 76 T-PEG. The mean follow-up
was 3.9 years (standard deviation = 9.6). Age, weight, and associated comorbidities
were comparable (p > 0.05). The overall complications were 17 (24.2%) in the P-PEG group and 16 (21.0%)
in the T-PEG group (p > 0.05). P-PEG was associated with more sedation for button replacement (97 vs. 2.6%
[p < 0.05]). P-PEG was associated with more early tube dislodgement during the first
replacement (7.2 vs. 1.4% [p = 0.092]). Two of the five dislodged gastrostomies in the P-PEG group underwent laparotomy
due to peritonitis, whereas the only dislodged gastrostomy in the T-PEG group was
solved endoscopically. Altogether, P-PEG was associated with more complications that
required urgent endoscopy, laparotomy, or laparoscopy (18.6 vs. 6.6% [p < 0.05]).
Conclusions P-PEG was associated with more sedation, complications during first button replacement,
and complications requiring urgent endoscopy, laparotomy, or laparoscopy compared
with T-PEG.
Keywords
gastrostomy - postoperative complications - endoscopy
