Testing a new method for training medical doctors in percutaneous endoscopic gastrostomy in palliative pediatrics

The main problem in training pediatric surgeons and endoscopists in the technique of performing percutaneous gastrostomy is associated with its relatively rare use in children, which in turn leads to a lack of consistent clinical practice among specialists, while percutaneous endoscopic gastrostomy (PEG) is considered the optimal method for correcting dysphagia in palliative pediatrics. A new method of training specialists in performing PEG in children is suggested. In an experimental operating setting, PEG procedures were performed on Chinchilla rabbits weighing 2.5–3.0 kg using a proprietary PEG placement kit with a 15 Fr tube size. Additionally, one PEG procedure was performed using reusable instruments and a 24 Fr Pezzer’s catheter, and four procedures were carried out with an 18 Fr Pezzer’s catheter using a specially developed tip for gastrostomy tube insertion. Flexible endoscopy with a 2.8 mm outer diameter, LED illumination, and an integrated visualization system was used for fibrogastroscopy. All stages of the procedure were practiced and studied through repeated repetitions. There was no significant difference in the technique of the procedure when applying PEG using a disposable proprietary kit versus using a Pezzer’s catheter with a special attachment. During the study, an original external fixation plate for securing the gastrostomy tube was developed and successfully used for 18 Fr Pezzer’s catheters. The size of the rabbits allows for training in all stages of PEG in pediatrics. The relative rarity of cases requiring gastrostomy in sick children hinders the training of PEG specialists. Theoretical training alone does not allow for acquiring the manual skills required to perform the procedure. Repeated performance of the procedure on animals enables the study of all stages of the operation, facilitates improvement of the technique, and the development of new devices and adaptations. The developed external fixation plate offers structural advantages compared to standard proprietary devices and will be in demand in clinical practice.