PERCUTANEOUS ENDOSCOPIC GASTROSTOMY WITH T-BAR FIXATION IN CHILDREN

Percutaneous endoscopic gastrostomy (PEG) with the Ponsky ''pull'' tec hnique has been the standard technique for pediatric gastrostomy tube placement since 1979. We evaluated safety and efficacy of PEG with the ''push'' technique and T-bar fixation. We reviewed PEGs performed in pediatric patients (less than or equal to 17 years) over a 31-month pe riod, excluding patients with previous abdominal surgery. We evaluated age, indications, location, time, and complications. Endoscopy was pe rformed, the stomach insufflated, and the anterior abdominal wall tran silluminated. T-bar fasteners were inserted percutaneously under endos copic control. Fasteners were ejected from the needle tip with a style t and secured. A 14 or 18 French gastrostomy tube was placed through t he center of previously placed T-bar fasteners by using a modified Sel dinger technique. Fifteen children (mean age, 9 years) underwent the p rocedure for the need for long-term enteral alimentation (severe close d head injury) (n = 7), for progressive neurologic dysfunction with fe eding disorder (n = 7), or for failure to thrive (cystic fibrosis) (n = 1). No significant major postoperative complications occurred. The t echnique proved safe and effective for gastrostomy in children.