6 Gastrostomy-associated peritonitis in children on chronic peritoneal dialysis
Yew-Wei Tan1, Andi-Romeo Eremie1, Michelle Blaauw2, Eileen Brennan2, Lesley Rees2, Kate Cross1
1Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom. 2Nephrology Department, Great Ormond Street Hospital for Children, London, United Kingdom

Abstract

Aims: Our published data on paediatric gastrostomy requiring peritoneal dialysis (PD) showed an increased peritonitis associated with percutaneous (percutaneous endoscopic or radiological gastrostomy–PEG/RIG) vs. Stamm technique, and gastrostomy insertion post-PD-catheter placement. This study aimed to systematically review our recent experience for comparison.

Methods: Concomitant gastrostomy and PD-catheter in 2006-2016 were retrospectively reviewed. Co-existence of gastrostomy with each PD-catheter was analysed as an independent event, with nasogastric feed (NG) as control. PD fluid≥100x10^6/L leukocytes (≥50% neutrophil), or treated for peritonitis for>48h, were regarded as peritonitis.

Primary end point was peritonitis/catheter-year. This was analysed in the overall group comparing gastrostomy to control, and also between gastrostomy techniques i.e. percutaneous (PEG/RIG) vs. Stamm (open/laparoscopic). The timing of gastrostomy insertion in relation to PD catheter was reviewed. Statistics: data were median (range), comparison with Mann-Whitney U-test.

Results: 38 children (17 girls) had concomitant gastrostomy and PD-catheter attributing to 50 PD catheters (events); control group had 13 patients (7 girls) attributing to 15 PD catheter (events). Overall, there were a total of 54.1 PD-catheter-years in the gastrostomy group with 49 peritonitis episodes (peritonitis/catheter-year=0.91, cf. historical 0.85).

The gastrostomy and control groups were comparable in median PD-catheter duration (306 vs. 445days, P=0.86) and peritonitis/catheter-year (0.61 vs. 0, P=0.66). There was no difference in peritonitis rate between percutaneous (n=37) vs. Stamm (n=13) technique [0.74 (0-33.2) vs. 0.41 (0-4.78), P=0.47], or timing of gastrostomy insertion, i.e. after (n=12) vs. before (n=38) PD-catheter placement [0.21 (0-4.35) vs. 0.69 (0-33.2), P=0.38].

Conclusion:  This is the largest series of paediatric PD in the presence of a gastrostomy. Overall, peritonitis rate was comparable to historical data, with no difference between concomitant gastrostomy/PD-catheter and control group. Both percutaneous and Stamm techniques are acceptable, and timing does not appear to be critical.


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