S2941 Laparoscopic vs Endoscopic Gastrostomies in Pediatric Patients, With Insights Into Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy: An Updated Systematic Review and Meta-Analysis

Introduction: Gastrostomy tubes are essential for children requiring long-term enteral nutrition. Placement techniques include percutaneous endoscopic gastrostomy (PEG), laparoscopic gastrostomy (LG), and laparoscopic-assisted PEG (LAPEG). The optimal approach remains debated, particularly regarding safety. We conducted a meta-analysis of over 11,000 pediatric cases to compare complication profiles, feeding outcomes, and procedural metrics, with insight into LAPEG. Methods: We systematically reviewed 42 studies evaluating PEG, LG, and LAPEG in children. Primary outcomes included major complications (e.g., peritonitis, organ injury, return to the operating room) and minor complications (e.g., wound infections, granulation tissue, dislodgement, leakage), along with time to enteral feeding and operative parameters. Data were pooled using random-effects to calculate odds ratios (ORs) and mean differences with 95% confidence intervals (CI). Heterogeneity was assessed with the I². Results: PEG had significantly higher odds of major complications compared to LG (OR 1.75, 95% CI 1.10–2.79, P = 0.02). However, PEG reduced the odds of minor complications by 29% compared to LG (OR 0.72, 95% CI 0.54–0.97, P = 0.03). Compared to PEG, LAPEG was associated with significantly higher odds of minor complications (OR 1.90, 95% CI 1.12–3.22, P = 0.02) and leak formation (OR 2.29, 95% CI 1.21–4.31, P = 0.01). Compared to LG, LAPEG had significantly lower odds of postoperative complications (OR 0.59, 95% CI 0.36–0.98, P = 0.04) and no differences in other adverse events. Feeding outcomes, including time to start and reach full enteral feeding, were comparable across all techniques. PEG had the shortest procedural time (mean difference –22.9 minutes vs LG, P < 0.01), while LAPEG was faster than LG and approached PEG in efficiency. Hospital length of stay did not differ significantly among groups. Conclusion: Laparoscopic approaches, particularly LG and LAPEG, are associated with reduced major and postoperative complications compared to PEG, without compromising feeding outcomes. While PEG offers shorter procedural time and fewer minor complications compared to LG, it carries a higher risk of major adverse events. LAPEG represents a valuable hybrid approach, with favorable postoperative safety compared to LG and procedural efficiency approaching that of PEG. These findings support the preferential use of laparoscopic techniques, especially LAPEG, when feasible, to improve safety in pediatric gastrostomy placement.