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.