The Insertion and Management of Gastrostomies in Children in the United Kingdom – A Survey of Practice

Gastrostomy insertion is one of the most frequently performed procedures by specialist paediatric surgeons. We aimed to determine practice across the United Kingdom (UK) and in particular to identify areas where there was consistency or variation in practice between practitioners and centres. A structured survey was distributed to all consultant practitioners who insert gastrostomies in the UK. Practice surrounding a range of aspects of gastrostomy care including insertion technique, device use, post-operative management and subsequent care were determined. Of total 135 practitioners who insert gastrostomies, responses were received from 103 (76%) with responses received from all UK centres. There was variation between centres in the provision of pre-operative information, and between practitioners in preferred device, insertion techniques, post-operative feeding practice and change/removal procedures. The most frequently preferred device for primary gastrostomy insertion was a Freka® PEG (36%) button device (30%), CorFlo™ PEG (21%), or G-tube (10%). Laparoscopy was always used when inserting either PEG or button device by over 50% of respondents and selectively used by the majority of the remainder. Feeds were started between 1 and 24 h post-insertion, most practitioners (64%) plan a minimum one night hospital stay but a third plan for more than one night. There is considerable variation in practice for most stages of the pathway for children having a gastrostomy. Further work is warranted to understand the relationship between different practices and patient outcomes, resource use and cost and subsequently to develop best practice guidelines. 3. •What is currently known about this topic? Gastrostomy insertion is one of the most common procedures performed by specialist children's surgeons. A range of techniques and practices exist surrounding insertion, post-operative and subsequent care.•What new information is contained in this article? This national survey provides an overview of the frequency of use of gastrostomy devices, insertion techniques and practices surrounding peri- and post-operative care in the United Kingdom. We identify a wide variation in practice between centres and surgeons which is difficult to justify and is suggestive of a poor underlying evidence base. Where there is variation, there may be opportunity for further research to identify optimum care pathways