Objectives: Percutaneous endoscopic gastrostomy (PEG) tube feeding is a convenient method for children requiring long-term enteral nutrition. Preoperative fitness of the majority of pediatric PEG candidates is graded as American Society of Anesthesiologists physical status ≥ III, indicating increased risk for peri- and postoperative morbidity. The success rate of endoscopic insertion is high, but variations in the anatomy may lead to failure of PEG placement and repeated exposure to anesthesia for surgical gastrostomy. We evaluated the efficiency of using abdominal plain film with gastric insufflation in the preparatory phase to predict a successful PEG insertion and avoid rescheduling.
Methods: A single-center cohort of candidates for PEG underwent abdominal plain film with gastric insufflation in the preparatory phase before tube insertion. The x-ray film was considered normal when the stomach projected distal to the costal margin. Primary endpoint was the success rate of PEG insertion. Multivariate logistic regression analysis was used to identify factors associated with PEG insertion failure.
Results: A total of 303 candidates for PEG underwent abdominal plain film (age range 0.3-18.1 years). PEG tube insertion succeeded in 287 cases (95%). In case of an abnormal abdominal film, the probability of successful PEG insertion dropped to 67% (95% confidence interval 46%-87%). In a multivariate logistic regression model, significant predictors for PEG insertion failure were spinal deformities (odds ratio [OR] 12.1), previous abdominal surgery (OR 8.5), neurological impairment (OR 4.1), and abnormal plain abdominal film (OR 10.3).
Conclusions: Assessment of the gastric anatomy by abdominal plain film in PEG candidates with spinal deformities, previous abdominal surgery, or neurological impairment may help to identify children with a high likelihood of PEG insertion failure. This strategy enables the endoscopist to notify the surgeon in advance for a potential conversion and avoids repeated exposure to anesthesia.