Percutaneous endoscopic gastrostomy in children

Abstract

PurposePercutaneous endoscopic gastrostomy (PEG) can improve nutritional status and reduce the amount of time needed to feed neurologically impaired children. We evaluated the characteristics, complications, and outcomes of neurologically impaired children treated with PEG.MethodsWe retrospectively reviewed the records of 32 neurologically impaired children who underwent PEG between March 2002 and August 2008 at our medical center. Forty-two PEG procedures comprising 32 PEG insertions and 10 PEG exchanges, were performed. The mean follow-up time was 12.2 (6.6) months.ResultsMean patient age was 9.4 (4.5) years. The main indications for PEG insertion were swallowing difficulty with GI bleeding due to nasogastric tube placement and/or the presence of gastroesophageal reflux disease (GERD). The overall rate of complications was 47%, with early complications evident in 25% of patients and late complications in 22%. The late complications included one gastro-colic fistula, two cases of aggravated GERD, and four instances of wound infection. Among the 15 patients with histological evidence of GERD before PEG, 13 (87%) had less severe GERD, experienced no new aspiration events, and showed increased body weight after PEG treatment.ConclusionPEG is a safe, effective, and relatively simple technique affording long-term enteral nutritional support in neurologically impaired children. Following PEG treatment, the body weight of most patients increased and the levels of vomiting, GI bleeding, and aspiration fell. We suggest that PEG with post-procedural observation be considered for enteral nutritional support of neurologically impaired children.

Percutaneous gastrostomy tubes in children with Pierre Robin sequence: efficacy, maintenance and complications

“…The 5% incidence of early major complication is similar to the rate of incidence found in other published reports from this institution [20,22] and is similar to a meta-analysis by Wollman et al (5.9%) [27]. The minorcomplication rate (21%) and overall complication rate in this study (total of early and late, major and minor, 27%), compares favourably with that of other reports of children undergoing different methods of insertion (11.7-73%) [20,22,23,25,26,28]. Tube maintenance issues of blockages, dislodgement, leak, malfunction, etc., are also common amongst all gastrostomy tube types [20,22,28].…”

“…The mean age at G-tube insertion in this group with PRS was 66 days (range 7-167 days, median 60 days) and mean weight 4.27 kg (range 1-7 kg, median 4.3 kg) compared to a mean age 3.9 years (range 1 day-23 years, median 1.53 years) and weight 13.4 kg (range 1-77 kg, median 8.6 kg) of our total population referred for a G-tube at this institution (unpublished data). This patient population is also younger and smaller than the mean age and weight of other pediatric reports in the literature [22][23][24][25][26]. Despite these demographics, the high technical success rate of radiologically placed G-tube insertions in this study (100%) is similar to that found in a meta-analysis by Wollman et al [27] of 99.2% for radiologically placed G-tubes, and compares well to the rate of 95% for PEG and 98.5% placed by laparoscopy [23].…”

Percutaneous Endoscopic Gastrostomy in Neurological Patients

“…PEG placement is a common indication for endoscopy of the upper gastrointestinal tract (Park et al, 2011;Srinivasan et al, 2009), and is now much more widely used than surgical or radiological insertion. Rates of PEG insertion have risen in recent years: in 1989, 15,000 PEG tubes were placed; in 1995, 121,000 PEG tubes were placed, and in 2000, more than 216,000 tubes were inserted for feeding (Delegge, 2008;Grant et al, 1998;Roche, 2003;Duszak & Mabry, 2003).…”

“…Neurogenic indications for gastrostomy include dysphagia from a variety of causes, including stroke, brain injury, cerebral palsy, brain tumors, HIV encephalopathy, neonatal encephalopathy, and neurodegenerative syndromes; non-neurological indications include such conditions as head and neck cancer, surgery to the mouth and throat, aspiration, Crohn's disease, severe burns, and decompression of the stomach in obstructing intraabdominal malignancy (Buchholz, 1994;Laasch et al, 2003;Nishiwaki et al, 2009;ElMatary, 2008;Naik et al, 2009;Park et al, 2011). The most common indication for PEG in children and adults is neurogenic dysphagia (El-Matary, 2008;Miller et al, 1989;Nicholson et al, 2000;Friedman et al, 2004;Srivastava et al, 2005).…”

Percutaneous Endoscopic Gastrostomy in Infants and Children

“…In the past, surgical gastrostomy was used, but this procedure is highly invasive and is associated with numerous potential complications. 1 Since the first published report of a percutaneous endoscopic gastrostomy (PEG) in 1980 by Gauderer and Ponsky, 2 the procedure has been modified and improved several times. It has now replaced the surgical gastrostomy which was associated with a markedly higher rate of complications.…”