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Review
. 2018 Dec;34(12):1321-1327.
doi: 10.1007/s00383-018-4358-6. Epub 2018 Oct 5.

Comparison of major complications in children after laparoscopy-assisted gastrostomy and percutaneous endoscopic gastrostomy placement: a meta-analysis

Filip Sandberg  1   2 , Margrét Brands Viktorsdóttir  1   2 , Martin Salö  1   2 , Pernilla Stenström  1   2 , Einar Arnbjörnsson  3   4
Affiliations
Review

Comparison of major complications in children after laparoscopy-assisted gastrostomy and percutaneous endoscopic gastrostomy placement: a meta-analysis

Filip Sandberg et al. Pediatr Surg Int. 2018 Dec.

Abstract

Purpose: A meta-analysis was performed to compare the rates of the major complications associated with two gastrostomy tube placement techniques in a pediatric population: laparoscopy-assisted gastrostomy (LAG) and percutaneous endoscopic gastrostomy (PEG).

Methods: The PubMed electronic database was queried for comparative studies of the two insertion techniques. The Newcastle-Ottawa scale (NOS) was used for the assessment of the quality and risk of bias in the included studies. The main outcome measure was the frequency of major complications defined as the need for reoperation within 30 days or death. RevMan 5.3, was used, with a p < 0.05 indicating statistical significance.

Results: Eight studies including 1550 patients met the inclusion criteria. The risk for major complications was higher in PEG than in LAG 3.86 (95% confidence interval 1.90-7.81; p < 0.0002). The number needed to treat to reduce one major complication by performing LAG instead of PEG was 23. There were no randomized-controlled trials. Overall, the quality of the included studies was determined to be unsatisfactory.

Conclusions: PEG placement was associated with a significantly higher risk of major complications compared to LAG placement. Therefore, LAG should be the preferred method for gastrostomy tube placement in children.

Keywords: Complications; Gastrostomy in children; Laparoscopy-assisted gastrostomy; Meta-analyses; Percutaneous endoscopic gastrostomy.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Flowchart of the search process to locate articles to compare major complications after gastrostomy insertion in children with the percutaneous endoscopic and laparoscopy-assisted techniques
Fig. 2
Fig. 2
Forest plot showing major complications in children after laparoscopy-assisted gastrostomy versus percutaneous endoscopic gastrostomy tube insertion. PEG percutaneous endoscopic gastrostomy, LAG laparoscopy-assisted gastrostomy, M–H Mantel–Haenszel, CI confidence interval
Fig. 3
Fig. 3
Funnel plot to assess bias in reports on major complications in children undergoing laparoscopy-assisted gastrostomy and percutaneous endoscopic gastrostomy for tube insertion. The X axis shows odds ratio, OR, and the Y axis shows the inverse standard error, the log of the OR
See this image and copyright information in PMC

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