Prevalence of Gastrostomy-Related Procedures in Polish Children: A Longitudinal Nationwide Analysis
Abstract
1. Introduction
2. Materials and Methods
- (a)
- Code 43.11 (including extensions): percutaneous endoscopic gastrostomy—this procedure includes endoscopic gastrostomy, hereafter described as PEG;
- (b)
- Code 43.19: other gastrostomy—this procedure includes surgical (laparoscopic or open) gastrostomy creation and procedures for replacement of the primary or subsequent gastrostomy tube, further described as gastrostomy-other;
- (c)
- Code 44.321: percutaneous endoscopic gastrojejunostomy—in this procedure, PEG-PEJ tubes are inserted, hereafter described as PEG-PEJ.
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
PEG | Percutaneous Endoscopic Gastrostomy |
HEN | Home Enteral Nutrition |
ICD—9 | International Classification of Diseases, Ninth Revision |
PEJ | Percutaneous Endoscopic Jejunostomy |
ICD—10 | International Statistical Classification of Diseases and Related Health Problems, Tenth Revision |
ESPGHAN | European Society for Paediatric Gastroenterology, Hepatology and Nutrition |
References
- Balogh, B.; Kovács, T.; Saxena, A.K. Complications in Children with Percutaneous Endoscopic Gastrostomy (PEG) Placement. World J. Pediatr. 2019, 15, 12–16. [Google Scholar] [CrossRef]
- Brewster, B.D.; Weil, B.R.; Ladd, A.P. Prospective Determination of Percutaneous Endoscopic Gastrostomy Complication Rates in Children: Still a Safe Procedure. Surgery 2012, 152, 714–721. [Google Scholar] [CrossRef]
- Åvitsland, T.L.; Kristensen, C.; Emblem, R.; Veenstra, M.; Mala, T.; Bjørnland, K. Percutaneous Endoscopic Gastrostomy in Children: A Safe Technique with Major Symptom Relief and High Parental Satisfaction. J. Pediatr. Gastroenterol. Nutr. 2006, 43, 624–628. [Google Scholar] [CrossRef] [PubMed]
- Viktorsdóttir, M.B.; Óskarsson, K.; Gunnarsdóttir, A.; Sigurdsson, L. Percutaneous Endoscopic Gastrostomy in Children: A Population-Based Study from Iceland, 1999–2010. J. Laparoendosc. Adv. Surg. Tech. 2015, 25, 248–251. [Google Scholar] [CrossRef]
- Suh, C.; Kim, W.; Eun, B.-L.; Shim, J.O. Percutaneous Endoscopic Gastrostomy and Nutritional Interventions by the Pediatric Nutritional Support Team Improve the Nutritional Status of Neurologically Impaired Children. J. Clin. Med. 2020, 9, 3295. [Google Scholar] [CrossRef] [PubMed]
- Åvitsland, T.L.; Birketvedt, K.; Bjørnland, K.; Emblem, R. Parent-Reported Effects of Gastrostomy Tube Placement. Nutr. Clin. Pract. 2013, 28, 493–498. [Google Scholar] [CrossRef] [PubMed]
- Akay, B.; Capizzani, T.R.; Lee, A.M.; Drongowski, R.A.; Geiger, J.D.; Hirschl, R.B.; Mychaliska, G.B. Gastrostomy Tube Placement in Infants and Children: Is There a Preferred Technique? J. Pediatr. Surg. 2010, 45, 1147–1152. [Google Scholar] [CrossRef]
- Merli, L.; De Marco, E.A.; Fedele, C.; Mason, E.J.; Taddei, A.; Paradiso, F.V.; Catania, V.D.; Nanni, L. Gastrostomy Placement in Children: Percutaneous Endoscopic Gastrostomy or Laparoscopic Gastrostomy? Surg. Laparosc. Endosc. Percutan. Tech. 2016, 26, 381–384. [Google Scholar] [CrossRef]
- Baker, L.; Beres, A.L.; Baird, R. A Systematic Review and Meta-Analysis of Gastrostomy Insertion Techniques in Children. J. Pediatr. Surg. 2015, 50, 718–725. [Google Scholar] [CrossRef]
- Koh, C.; Nicoara, C.D.; Lansdale, N.; Peters, R.T.; Wilkinson, D.J. Endoscopic vs Laparoscopic Paediatric Gastrostomies: Time to Change Our Practice? J. Pediatr. Surg. 2021, 56, 1317–1321. [Google Scholar] [CrossRef]
- Zamakhshary, M.; Jamal, M.; Blair, G.K.; Murphy, J.J.; Webber, E.M.; Skarsgard, E.D. Laparoscopic vs Percutaneous Endoscopic Gastrostomy Tube Insertion: A New Pediatric Gold Standard? J. Pediatr. Surg. 2005, 40, 859–862. [Google Scholar] [CrossRef] [PubMed]
- Jacob, A.; Delesalle, D.; Coopman, S.; Bridenne, M.; Guimber, D.; Turck, D.; Gottrand, F.; Michaud, L. Safety of the One-Step Percutaneous Endoscopic Gastrostomy Button in Children. J. Pediatr. 2015, 166, 1526–1528. [Google Scholar] [CrossRef] [PubMed]
- Berman, L.; Baird, R.; Sant’Anna, A.; Rosen, R.; Petrini, M.; Cellucci, M.; Fuchs, L.; Costa, J.; Lester, J.; Stevens, J.; et al. Gastrostomy Tube Use in Pediatrics: A Systematic Review. Pediatrics 2022, 149, e2021055213. [Google Scholar] [CrossRef] [PubMed]
- Sutherland, C.; Carr, B.; Biddle, K.Z.; Jarboe, M.; Gadepalli, S.K. Pediatric Gastrostomy Tubes and Techniques: Making Safer and Cleaner Choices. J. Surg. Res. 2017, 220, 88–93. [Google Scholar] [CrossRef]
- Suksamanapun, N.; Mauritz, F.; Franken, J.; van der Zee, D.; van Herwaarden-Lindeboom, M. Laparoscopic versus Percutaneous Endoscopic Gastrostomy Placement in Children: Results of a Systematic Review and Meta-Analysis. J. Minim. Access Surg. 2017, 13, 81. [Google Scholar] [CrossRef]
- Salazar, J.H.; Spanbauer, C.; Sood, M.R.; Densmore, J.C.; Van Arendonk, K.J. Variability in the Method of Gastrostomy Placement in Children. Children 2020, 7, 53. [Google Scholar] [CrossRef]
- Di Leo, G.; Pascolo, P.; Hamadeh, K.; Trombetta, A.; Ghirardo, S.; Schleef, J.; Barbi, E.; Codrich, D. Gastrostomy Placement and Management in Children: A Single-Center Experience. Nutrients 2019, 11, 1555. [Google Scholar] [CrossRef]
- Sullivan, P.B.; Juszczak, E.; Bachlet, A.M.; Thomas, A.G.; Lambert, B.; Vernon-Roberts, A.; Grant, H.W.; Eltumi, M.; Alder, N.; Jenkinson, C. Impact of Gastrostomy Tube Feeding on the Quality of Life of Carers of Children with Cerebral Palsy. Dev. Med. Child Neurol. 2004, 46, 796–800. [Google Scholar] [CrossRef]
- O’Brien, K.; Scaife, J.; Iantorno, S.; Bucher, B. Caregiver Health-Related Quality of Life 1 Year Following Pediatric Gastrostomy Tube Placement. Surg. Open Sci. 2022, 10, 111–115. [Google Scholar] [CrossRef]
- Pemberton, J.; Frankfurter, C.; Bailey, K.; Jones, L.; Walton, J.M. Gastrostomy Matters—The Impact of Pediatric Surgery on Caregiver Quality of Life. J. Pediatr. Surg. 2013, 48, 963–970. [Google Scholar] [CrossRef]
- Franken, J.; Stellato, R.K.; Tytgat, S.H.A.J.; van der Zee, D.C.; Mauritz, F.A.; Lindeboom, M.Y.A. The Effect of Gastrostomy Placement on Health-Related Quality of Life in Children. J. Pediatr. Surg. 2019, 54, 2268–2273. [Google Scholar] [CrossRef] [PubMed]
- Jeličić Kadić, A.; Radošević, T.; Žitko, V.; Despot, R.; Pogorelić, Z.; Llorente Muñoz, C.M.; Runjić, E.; Kovačević, T.; Ćatipović Ardalić, T.; Polić, B.; et al. Percutaneous Endoscopic Gastrostomy Tubes Can Be Considered Safe in Children: A Single-Center 11-Year Retrospective Analysis. Medicina 2021, 57, 1236. [Google Scholar] [CrossRef]
- Homan, M.; Hauser, B.; Romano, C.; Tzivinikos, C.; Torroni, F.; Gottrand, F.; Hojsak, I.; Dall’Oglio, L.; Thomson, M.; Bontems, P.; et al. Percutaneous Endoscopic Gastrostomy in Children. J. Pediatr. Gastroenterol. Nutr. 2021, 73, 415–426. [Google Scholar] [CrossRef]
- Fascetti-Leon, F.; Gamba, P.; Dall’Oglio, L.; Pane, A.; de’ Angelis, G.L.; Bizzarri, B.; Fava, G.; Maestri, L.; Cheli, M.; Di Nardo, G.; et al. Complications of Percutaneous Endoscopic Gastrostomy in Children: Results of an Italian Multicenter Observational Study. Dig. Liver Dis. 2012, 44, 655–659. [Google Scholar] [CrossRef]
- Szlagatys-Sidorkiewicz, A.; Borkowska, A.; Popińska, K.; Toporowska-Kowalska, E.; Grzybowska-Chlebowczyk, U.; Wernicka, A.; Hapyn, E.; Sibilska, M.; Gębora-Kowalska, B.; Więcek, S.; et al. Complications of PEG Are Not Related to Age—The Result of 10-Year Multicenter Survey. Adv. Med. Sci. 2016, 61, 1–5. [Google Scholar] [CrossRef]
- Glasson, E.J.; Wong, K.; Leonard, H.; Forbes, D.; Ravikumara, M.; Mews, C.; Jacoby, P.; Bourke, J.; Trollor, J.; Srasuebkul, P.; et al. Evolving Trends of Gastrostomy Insertion Within a Pediatric Population. J. Pediatr. Gastroenterol. Nutr. 2018, 67, e89–e94. [Google Scholar] [CrossRef]
- Kvello, M.; Åvitsland, T.L.; Knatten, C.K.; Pripp, A.H.; Aabakken, L.; Emblem, R.; Bjørnland, K. Trends in the Use of Gastrostomies at a Tertiary Paediatric Referral Centre. Scand. J. Gastroenterol. 2016, 51, 625–632. [Google Scholar] [CrossRef]
- Backman, E.; Sjögreen, L. Gastrostomy Tube Insertion in Children with Developmental or Acquired Disorders: A Register-based Study. Dev. Med. Child Neurol. 2020, 62, 1191–1197. [Google Scholar] [CrossRef]
- Pardy, C.; Kharma, N.; Lau, R.; Kelly, V.; Yardley, I. Point Prevalence of Gastrostomy in a Paediatric Population. J. Pediatr. Gastroenterol. Nutr. 2021, 72, 528–531. [Google Scholar] [CrossRef] [PubMed]
- Poskanzer, S.A.; Hobensack, V.L.; Ciciora, S.L.; Santoro, S.L. Feeding Difficulty and Gastrostomy Tube Placement in Infants with Down Syndrome. Eur. J. Pediatr. 2020, 179, 909–917. [Google Scholar] [CrossRef] [PubMed]
- Garne, E.; Tan, J.; Loane, M.; Baldacci, S.; Ballardini, E.; Brigden, J.; Cavero-Carbonell, C.; García-Villodre, L.; Gissler, M.; Given, J.; et al. Gastrostomy and Congenital Anomalies: A European Population-Based Study. BMJ Paediatr. Open 2022, 6, e001526. [Google Scholar] [CrossRef]
- Wong, K.; Leonard, H.; Pearson, G.; Glasson, E.J.; Forbes, D.; Ravikumara, M.; Jacoby, P.; Bourke, J.; Srasuebkul, P.; Trollor, J.; et al. Epidemiology of Gastrostomy Insertion for Children and Adolescents with Intellectual Disability. Eur. J. Pediatr. 2019, 178, 351–361. [Google Scholar] [CrossRef]
- Dahlseng, M.O.; Andersen, G.L.; Da Graca Andrada, M.; Arnaud, C.; Balu, R.; De La Cruz, J.; Folha, T.; Himmelmann, K.; Horridge, K.; Júlíusson, P.B.; et al. Gastrostomy Tube Feeding of Children with Cerebral Palsy: Variation across Six European Countries. Dev. Med. Child Neurol. 2012, 54, 938–944. [Google Scholar] [CrossRef] [PubMed]
- Krom, H.; van Zundert, S.M.C.; Otten, M.-A.G.M.; van der Sluijs Veer, L.; Benninga, M.A.; Kindermann, A. Prevalence and Side Effects of Pediatric Home Tube Feeding. Clin. Nutr. 2019, 38, 234–239. [Google Scholar] [CrossRef]
- Skogar, M.L.; Sundbom, M. Time Trends and Outcomes of Gastrostomy Placement in a Swedish National Cohort over Two Decades. World J. Gastroenterol. 2024, 30, 1358–1367. [Google Scholar] [CrossRef] [PubMed]
- Lezo, A.; Capriati, T.; Spagnuolo, M.I.; Lacitignola, L.; Goreva, I.; Di Leo, G.; Cecchi, N.; Gandullia, P.; Amarri, S.; Forchielli, M.L.; et al. Paediatric Home Artificial Nutrition in Italy: Report from 2016 Survey on Behalf of Artificial Nutrition Network of Italian Society for Gastroenterology, Hepatology and Nutrition (SIGENP). Nutrients 2018, 10, 1311. [Google Scholar] [CrossRef] [PubMed]
- Daveluy, W.; Guimber, D.; Uhlen, S.; Lescut, D.; Michaud, L.; Turck, D.; Gottrand, F. Dramatic Changes in Home-based Enteral Nutrition Practices in Children During an 11-year Period. J. Pediatr. Gastroenterol. Nutr. 2006, 43, 240–244. [Google Scholar] [CrossRef]
- Smith, T.; Micklewright, A.; Hirst, A.; Stratton, R.; Baxter, J. Annual BANS Report, 2011; British Association of Parenteral and Enteral Nutrition: Worcestershire, UK, 2011; Available online: https://www.bapen.org.uk/pdfs/bans_reports/bans_report_11.pdf (accessed on 15 August 2025).
- Wyszomirska, K.; Wyszomirski, A.; Brzeziński, M.; Borkowska, A.; Zagierski, M.; Kierkuś, J.; Ksiażyk, J.; Romanowska, H.; Świder, M.; Toporowska-Kowalska, E.; et al. Home Artificial Nutrition in Polish Children: An Analysis of 9-Year National Healthcare Provider Data. Nutrients 2021, 13, 1007. [Google Scholar] [CrossRef]
- Szlagatys-Sidorkiewicz, A.; Popińska, K.; Toporowska-Kowalska, E.; Borkowska, A.; Sibilska, M.; Gębora-Kowalska, B.; Kłęk, S.; Hapyn, E.; Kierkuś, J.; Grzybowska-Chlebowczyk, U.; et al. Home Enteral Nutrition in Children—2010 Nationwide Survey of the Polish Society for Clinical Nutrition of Children. Eur. J. Pediatr. 2012, 171, 719–723. [Google Scholar] [CrossRef]
- Heuschkel, R.B.; Gottrand, F.; Devarajan, K.; Poole, H.; Callan, J.; Dias, J.A.; Karkelis, S.; Papadopoulou, A.; Husby, S.; Ruemmele, F.; et al. ESPGHAN Position Paper on Management of Percutaneous Endoscopic Gastrostomy in Children and Adolescents. J. Pediatr. Gastroenterol. Nutr. 2015, 60, 131–141. [Google Scholar] [CrossRef]
- Folwarski, M.; Klek, S.; Brzeziński, M.; Szlagatys-Sidorkiewicz, A.; Wyszomirski, A.; Meyer-Szary, J.; Skonieczna-Żydecka, K. Prevalence and Trends in Percutaneous Endoscopic Gastrostomy Placement: Results From a 10-Year, Nationwide Analysis. Front. Nutr. 2022, 9, 906409. [Google Scholar] [CrossRef] [PubMed]
- Mirmozaffari, M.; Kamal, N. A Data Envelopment Analysis Model for Optimizing Transfer Time of Ischemic Stroke Patients under Endovascular Thrombectomy. Healthc. Anal. 2024, 6, 100364. [Google Scholar] [CrossRef]
PEG 1 | Gastrostomy-Other | ||||
---|---|---|---|---|---|
Year | Paediatric Population (n) | Patients (Prevalence) | Procedures (Prevalence) | Patients (Prevalence) | Procedures (Prevalence) |
2010 | 7,140,156 | 191 (2.68) | 202 (2.83) | 160 (2.24) | 187 (2.62) |
2011 | 7,146,551 | 188 (2.63) | 202 (2.83) | 158 (2.21) | 171 (2.39) |
2012 | 7,066,768 | 252 (3.57) | 269 (3.81) | 191 (2.7) | 257 (3.64) |
2013 | 6,995,362 | 254 (3.63) | 274 (3.92) | 180 (2.57) | 277 (3.96) |
2014 | 6,942,996 | 332 (4.78) | 355 (5.11) | 218 (3.14) | 330 (4.75) |
2015 | 6,901,795 | 298 (4.32) | 313 (4.54) | 222 (3.22) | 303 (4.39) |
2016 | 6,895,878 | 268 (3.89) | 284 (4.12) | 239 (3.47) | 361 (5.24) |
2017 | 6,920,652 | 258 (3.73) | 276 (3.99) | 285 (4.12) | 451 (6.52) |
2018 | 6,935,523 | 257 (3.71) | 271 (3.91) | 221 (3.19) | 386 (5.57) |
2019 | 6,948,706 | 340 (4.89) | 357 (5.14) | 213 (3.07) | 280 (4.03) |
2010–2019 | Mann–Kendall trend test | tau = 0.51, p-value = 0.049 | tau = 0.56, p-value = 0.032 |
Age Group | Paediatric Population (n) | Patients (Prevalence) | Procedures (Prevalence) |
---|---|---|---|
Total/Girls/Boys | Total/Girls/Boys | Total/Girls/Boys | |
0–2 | 1,164,679/566,045/598,634 | 1506 (129.31) #/687 (121.37)/819 (136.81) | 1845 (158.41)/815 (143.98)/1030 (172.06) |
3–5 | 1,188,571/578,309/610,262 | 673 (56.62) #/312 (53.95)/361 (59.15) | 904 (76.06)/405 (70.03)/499 (81.77) |
6–9 | 1,563,289/761,120/802,169 | 787 (50.34) #/371 (48.47)/416 (51.86) | 1032 (66.01)/495 (65.04)/537 (66.94) |
10–13 | 1,506,999/734,184/772,815 | 718 (47.64) #/322 (43.86)/396 (51.24) | 867 (57.53)/420 (57.21)/447 (57.84) |
14–18 | 1,565,900/763,540/802,360 | 836 (53.39) #/352 (46.1)/484 (60.32) | 1093 (69.8)/477 (62.47)/616 (76.77) |
ICD—10 1 Diagnoses | Number of Patients | % |
---|---|---|
Other * | 1125 | 23.70% |
R Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified | 1117 | 23.40% |
R13 Dysphagia | 529 | 11.10% |
R63 Symptoms and signs concerning food and fluid intake | 515 | 10.80% |
R62 Lack of expected normal physiological development | 73 | 1.50% |
Z Factors influencing health status and contact with health services | 826 | 17.40% |
Z43 Attention to artificial openings | 816 | 17.20% |
Z51 Other medical care | 5 | 0.10% |
Z93 Artificial opening status | 5 | 0.10% |
K Diseases of the digestive system | 677 | 14.20% |
K21 Gastro-oesophageal reflux disease | 375 | 7.90% |
K31 Other diseases of stomach and duodenum | 176 | 3.70% |
K22 Other diseases of oesophagus | 63 | 1.30% |
K29 Gastritis and duodenitis | 49 | 1.00% |
K92 Other diseases of digestive system | 14 | 0.30% |
J Diseases of the respiratory system | 415 | 8.80% |
J96 Respiratory failure, not elsewhere classified | 330 | 7.00% |
J18 Pneumonia, organism unspecified | 39 | 0.80% |
J15 Bacterial pneumonia, not elsewhere classified | 28 | 0.60% |
J95 Postprocedural respiratory disorders, not elsewhere classified | 13 | 0.30% |
J20 Acute bronchitis | 5 | 0.10% |
E Endocrine, nutritional, and metabolic diseases | 284 | 5.90% |
E43 Unspecified severe protein-energy malnutrition | 63 | 1.30% |
E41 Nutritional marasmus | 56 | 1.20% |
E46 Unspecified protein-energy malnutrition | 53 | 1.10% |
E84 Cystic fibrosis | 47 | 1.00% |
E44 Protein-energy malnutrition of moderate and mild degree | 43 | 0.90% |
E88 Other metabolic disorders | 11 | 0.20% |
E71 Disorders of branched-chain amino-acid metabolism and fatty-acid metabolism | 6 | 0.10% |
E76 Disorders of glycosaminoglycan metabolism | 5 | 0.10% |
G Diseases of the nervous system | 184 | 3.90% |
G80 Cerebral palsy | 96 | 2.00% |
G40 Epilepsy | 41 | 0.90% |
G12 Spinal muscular atrophy and related syndromes | 29 | 0.60% |
G93 Other disorders of brain | 13 | 0.30% |
G41 Status epilepticus | 5 | 0.10% |
Q Congenital malformations, deformations, and chromosomal abnormalities | 88 | 1.90% |
Q39 Congenital malformations of oesophagus | 65 | 1.40% |
Q40 Other congenital malformations of upper alimentary tract | 12 | 0.30% |
Q04 Other congenital malformations of brain | 6 | 0.10% |
Q87 Other specified congenital malformation syndromes affecting multiple systems | 5 | 0.10% |
S Injury, poisoning, and certain other consequences of external causes | 17 | 0.40% |
S06 Intracranial injury | 17 | 0.40% |
P Certain conditions originating in the perinatal period | 10 | 0.20% |
P07 Disorders related to short gestation and low birth weight, not elsewhere classified | 10 | 0.20% |
I Diseases of the circulatory system | 5 | 0.10% |
I46 Cardiac arrest | 5 | 0.10% |
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Wyszomirska, K.; Wyszomirski, A.; Brzeziński, M.; Borkowska, A.; Zagierska, A.; Zagierski, M.; Szlagatys-Sidorkiewicz, A. Prevalence of Gastrostomy-Related Procedures in Polish Children: A Longitudinal Nationwide Analysis. J. Clin. Med. 2025, 14, 6727. https://doi.org/10.3390/jcm14196727
Wyszomirska K, Wyszomirski A, Brzeziński M, Borkowska A, Zagierska A, Zagierski M, Szlagatys-Sidorkiewicz A. Prevalence of Gastrostomy-Related Procedures in Polish Children: A Longitudinal Nationwide Analysis. Journal of Clinical Medicine. 2025; 14(19):6727. https://doi.org/10.3390/jcm14196727
Chicago/Turabian StyleWyszomirska, Karolina, Adam Wyszomirski, Michał Brzeziński, Anna Borkowska, Agnieszka Zagierska, Maciej Zagierski, and Agnieszka Szlagatys-Sidorkiewicz. 2025. "Prevalence of Gastrostomy-Related Procedures in Polish Children: A Longitudinal Nationwide Analysis" Journal of Clinical Medicine 14, no. 19: 6727. https://doi.org/10.3390/jcm14196727
APA StyleWyszomirska, K., Wyszomirski, A., Brzeziński, M., Borkowska, A., Zagierska, A., Zagierski, M., & Szlagatys-Sidorkiewicz, A. (2025). Prevalence of Gastrostomy-Related Procedures in Polish Children: A Longitudinal Nationwide Analysis. Journal of Clinical Medicine, 14(19), 6727. https://doi.org/10.3390/jcm14196727