International Variation in Pediatric Gastrostomy Insertion Techniques and Perioperative Management: A Survey of Members of the European Pediatric Surgeons’ Association

The objective of this study is to characterize contemporary international practice in pediatric gastrostomy insertion and perioperative management. A cross-sectional electronic survey was developed by the European Pediatric Surgeons' Association (EUPSA) Network Office and distributed through the EUPSA network between June 2024 and January 2025. The survey contained 32 primary questions and addressed multiple aspects of the perioperative gastrostomy pathway. Responses were analyzed descriptively. Categorical variables were compared using chi-square or Fisher's exact tests, and continuous variables using the Mann–Whitney U test. Comparisons were performed between European and non-European, and high- and low-/middle-income settings. A two-sided p-value < 0.05 was considered statistically significant. A total of 181 pediatric surgical respondents from 132 cities across 59 countries were included. Of these, 117/181 (64.6%) completed the survey in full. Preferred primary gastrostomy insertion technique varied, with percutaneous endoscopic gastrostomy without laparoscopy preferred most frequently (59/137, 43.1%). Open gastrostomy was reported more frequently in low- and middle-income than high-income settings (11/35, 31.4% vs. 3/102, 2.9%; p < 0.001) and in non-European than European settings (12/45, 26.7% vs. 2/92, 2.2%; p < 0.001). Reported timing of postoperative gastrostomy use varied substantially; enteral feeding was initiated earlier in European than non-European settings and in high-income than low- and middle-income settings (median 8 vs. 24 hours for both comparisons; p < 0.001 for both). Pediatric gastrostomy practice varies substantially across the perioperative pathway, with important differences across geographic and economic settings. These findings highlight persistent uncertainty in key aspects of care and support the need for prospective outcome-based research, prioritization of key areas, and consensus development.