Percutaneous endoscopic gastrostomy in paediatric practice: Complications and outcome (original) (raw)
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Percutaneous Endoscopic Gastrostomy in Pediatric Patients
intechopen.com
Adequate nutrition is important in the management of children with chronic illnesses. Patients who are unwilling or unable to eat will starve. Starvation depletes tissue stores, and ultimately leads to impaired organ function and tissue structure. Appropriate caloric intake enables growth, promotes tissue repair, and improve immune function. Access to the intestinal tract may be via a nasal tube or by the percutaneous route, with delivery to the stomach or jejunum. Nasogastric tubes are employed for short-term feeding, usually up to four weeks. In children requiring long term tube feeding, nasogastric feeding may be uncomfortable, disfiguring and often traumatic. Percutaneous access is usually by either endoscopic or radiological techniques. Percutaneous gastrostomy is basically a sutureless approximation of the stomach to the abdominal wall. The percutaneous endoscopic gastrostomy (PEG) becomes the most popular technique nowadays. The first PEG was performed in the pediatric operating room of University Hospitals of Cleveland on June 12, 1979 on a four-and-half-month-old child with inadequate oral intake. The procedure was performed under sedation and local anesthesia. The child did remarkably well. However, because the initial tube used was a 12F catheter with small mushroom head, external migration ensued after 3 weeks. The catheter was changed under direct visualization, using a small laparotomy (Gauderer, 2002). Since then the procedure has been adopted worldwide for both children and adults. Because the procedure is considered minimally invasive, rapid, and associated with low risk of complications, and short hospital stay, it has become the preferred method for delivering nutritional support in vulnerable pediatric patients. The benefits not only include successful nutritional rehabilitation, but also accelerated growth (Craig et al., 2006, Sullivan et al., 2005) enhanced carer satisfaction (Avitsland et al., 2006) and quality of life (Sullivan et al., 2004). 2. Indications The main clinical indications for PEG placement in children are as follows (Table 1): 2.1 Inability to swallow Children with neurological impairment comprise the majority of this category. They often have difficulty eating and drinking. These difficulties are due to problems with oro
Percutaneous endoscopic gastrostomy in Children-Issues remain
2013
Background-Percutaneous endoscopic gastrostomy (PEG) is an important option for enteral nutrition for both children and adults. It is considered a safe, effective, and advantageous technique in comparison to other complementary feeding routes. It allows continuous feeding, the feeding of patients with swallowing disorders due to neurological causes or others, and the administration of non-palatable diets or medications, all with low rates of complications and mortality. Objective-This study aimed to evaluate the main indications and complications of PEG in pediatric patients. In addition, the impact on the nutritional status of patients undergoing PEG was also compared with weight, body mass index (BMI), and height according to references from the World Health Organization. Methods-This observational and retrospective study included 152 children and adolescents who underwent PEG between January/2003 and December/2018. Patients up to 18 years of age at the time of the procedure were included. Complications related to the procedure were classified as minor or major. Patients with PEG indication for nutritional supplementation were evaluated for weight gain, height, and BMI, using the Z score at the day of the procedure and six months, 1 year, and 2 years after the procedure. Results-Indications for PEG were: swallowing disorder of neurological cause (67.1%), need for nutritional supplementation (25%), swallowing disorder of mechanical origin (6.6%), and indication of gastric decompression (1.3%). Minor complications occurred in 57.8% of patients and major complications in 9.8% of patients. The traction technique corresponded to 92.1% and puncture to 7.9%. The death rate was 1.3%. Thirty-eight patients had an indication for nutritional supplementation. In these patients, there was a gradual increase in both BMI and weight, reaching statistically significant differences (P=0.0340 and P= 0.0105, respectively). These differences were more evident in chronic renal disease patients. Height did not vary significantly (P=0.543). Conclusion-PEG proved to be an advantageous option as an auxiliary feeding method in pediatric patients. Dysphagia of neurological origin was the main indication followed by the need for nutritional supplementation. PEG has low frequency of major complications and mortality. This study also showed the importance of PEG in patients who need nutritional supplementation, as it enabled patients to move from undernutrition to normal weight ranges.
Polish Annals of Medicine
IntroductionA long-term intragastric feeding is the indication for percutaneous endoscopic gastrostomy (PEG) placement in a patient. The procedure is performed in children with central nervous system (CNS) disorders, congenital heart defects and neoplastic or metabolic diseases. The PEG placement procedure is most commonly performed by a gastroscopy procedure.AimThe study aimed to retrospectively analyse the methods applied and complications following PEG tube insertion in patients of the Regional Specialist Children's Hospital in Olsztyn, Poland, in the years 2000–2019.Material and methodsA retrospective analysis was conducted of medical histories and records of children qualified for PEG placement procedure. PEG procedure was performed on 48 children: 24 boys and 24 girls. The mean age was 7 years. PEG was inserted in cerebral plasy in 30 patients, congenital defects in 11 and genetic disorders in 7.Results and discussionThe reasons for PEG insertion included dysphagia in 30 c...
Journal of Nepal Paediatric Society, 2014
Introduction: Nutrition is of paramount importance for adequate growth and development of a child. Various routes of providing enteral nutrition to a paediatric patient are by nasogastric, nasojejeunal and gastrostomy which can be placed surgically or endoscopically. The objectives of this study were to review cases with percutaneous endoscopic gastrostomy (PEG) procedure and patient characteristics, indications, complications and outcome of PEG tube insertion in children at our center. Materials and Methods: This was a prospective study carried out in Sir Ganga Ram Hospital in New Delhi, India for a period of two years from August 2010 to August 2012. It included patients in whom PEG tube were placed during the study period and have had at least one year of post procedure follow up. Demograhic details, duration of procedure, complications, initial weight and height and then at 3 month, 6 months and 12 months of PEG tube placement were also recorded. Data between groups was compared using ANOVA and within groups across follow-ups was done using paired t-test. Results: Fourty six PEG insertions were performed during the study period, 26 twenty six conversions to BRT or Mickey button and ten PEG removals. The main indications for PEG insertion were Cerebral palsy with feeding difficulty (47.8 %). Erythema at the PEG insertion site was the most common complication (21%). There was significant improvement in the weight and height in all age group of patients at 3, 6 and 12 months post procedure with a p value <0.5. The average weight gain after 3, 6 and 12 months was 1.3 kg, 2.8 kg and 4.2 kg and the average height gain after 3, 6 and 12 months was 1.6 cm, 2.5 cm and 4.13 cm respectively. Conclusions: PEG is effective means for optimizing the nutritional goals of patients who are nutritionally debilitated with minimal complications.
Percutaneous endoscopic gastrostomy in children: a single center study at Tertiary hospital Iran
Introduction: The aim of this study was to evaluate complications after percutaneous endoscopic gastrostomy among children who underwent percutaneous endoscopic gastrostomy in Nemazee hospital. Materials and methods: All children who underwent percutaneous endoscopic gastrostomy were included in the current study. Place of the study was department of pediatric gastroenterology of Nemazee children hospital of Shiraz university of medical sciences. Duration of the study was 5 year starting from 2008. All drugs such as aspirin, NSAIDS, and heparin were discontinued 1-7 days before procedures. All patients were kept NPO 6-8 hours before procedure according to the age. Single dose antibiotic was prescribed for all cases before procedure. During procedure, all patients were sedated using propofol and or midazolam. Some patients required intubation. Results: Of 39 cases who underwent PEG, 4 (10.2%) patients showed complication. The most common indication for PEG insertion were neurologic problem (84.6%) and metabolic disease (10.2%). Of our patients, 84.6% of the cases had the weight below third percentile. Conclusion: The most common indication for percutaneous endoscopic gastrostomy was cerebral palsy. The complication rate in our study was 10.2%. Celulitis was the most common complication. RESUMEN Introducción: El objetivo de este estudio fue evaluar las complicaciones luego de una gastrostomía endoscópica percutánea (PEG) en niños realizada en el hospital Nemazee. Material y métodos: Se incluyeron al estudio todos los niños que se realizaron PEG en el hospital. El lugar del estudio fue el departamento de gastroenterología pediátrica del Hospital para niños Nemazee de la Universidad Shiraz de ciencias médicas. La duración del estudio fue cinco años, iniciando en el año 2008. Todas las drogas como aspirina, AINES y heparina fueron suspendidas entre 1 a 7 días previos al procedimiento. Todos los pacientes estuvieron entre 6 a 8 horas del examen en ayunas dependiendo de la edad. Se prescribió una dosis de antibioterapia profiláctica en todos los casos previo al procedimiento. Durante el procedimiento, todos los pacientes fueron sedados usando propofol y/o midazolam. Algunos pacientes necesitaron intubación. Resultados: De 39 casos que se sometieron a PEG, 4 (10,2%) tuvieron alguna complicación. La indicación más frecuente de PEG fueron los problemas neurológicos (84,6%) y luego las enfermedades metabólicas (10,2%). De nuestros pacientes, 84,6% de los casos estuvieron por debajo del tercer percentile. Conclusión: La indicación más común de gastrostomía endoscópica percutánea fue la parálisis cerebral. La tasa de complicación en nuestro estudio fue 10,2%. La celulitis fue la complicación más común. Palabras clave: Endoscopía; Gastrostomía; Niño (fuente: DeCS BIREME).
Complications of Percutaneous Endoscopic Gastrostomy in Children: A Single Centre Experience
Journal of Pediatric Research, 2021
The aim of this study was to investigate the complications of percutaneous endoscopic gastrostomy in children. Materials and Methods: Ninety-one pediatric patients treated with percutaneous endoscopic gastrostomy (PEG) insertion by pull technique in a five-year period were enrolled into this study. Their hospital records were reviewed retrospectively for their demographic data, their primary diseases causing nutritional insufficiency, and any major or minor complications after PEG insertion. Results: The 91 patients who were included in this study were aged between 1 month and 18 years (median 79 months). 45.1% (n=41) of the patients were female. The majority of the patients (76.9%, n=70) had neurological diseases. Nineteen patients (20.9%) had metabolic diseases and two patients had cystic fibrosis (2.2%). We observed 37 (40.7%) complications in total. Three (3.3%) of them were major and 34 (37.4%) of them were minor complications. Conclusion: Endoscopic percutaneous gastrostomy placement is an important way to continue enteral feeding in children. Although PEG is a minimally invasive technique, there are some problems which may be experienced by the children and their parents after PEG insertion, the majority of the these being minor complications.
Journal of Pediatric Surgery, 2001
A study was conducted of the complications of percutaneous endoscopic gastrostomy (PEG) with or without antireflux surgery (ARS). A retrospective review was conducted of all patients, receiving a PEG in the period January 1993 through December 1997. Patients' characteristics including underlying disease, indications, results of preoperative screening, and complications were recorded. PEG placement was performed with the Seldinger technique and, in some cases, under laparoscopic control. In the event of a pathologic pH study during preoperative screening, laparoscopic antireflux surgery (ARS) was added. Mean age was 5 years and 10 months. The majority of the children were mentally retarded. The main indications for PEG were vomiting, food refusal, inability to swallow, and aspiration. Fifty-nine patients had PEG without ARS. Nineteen of these patients had concomitant laparoscopy. Thirty-seven patients had PEG with ARS. One patient died postoperatively of gastric leakage. PEG-related complications occurred in 31% of the patients. There was a significant higher incidence of complications in the group of patients that underwent ARS together with PEG compared with PEG placement without ARS. Roughly half of the complications were peristomal infection related to the use of T-fasteners and the other half gastroduodenal obstruction caused by the balloon of the gastrostomy catheter, both preventable complications. Preoperative vomiting without a positive pH-study disappeared in most cases after PEG placement. Although the pH study normalized in 34 of 37 patients after concomitant ARS, vomiting persisted in 7 of 17 patients. PEG improved the nutritional status in 75% of the children. PEG improved the nutritional status in the majority of the children. However, PEG placement can lead to a considerable amount of complications, especially when combined with ARS. ARS together with PEG is successful in treating GER but does not necessarily cure preexistent vomiting. PEG alone cures vomiting in 80% of the patients and rarely leads to vomiting. There seems no good reason for combining PEG with ARS. Only if symptoms progress after PEG, ARS should be considered. Caretakers and patients should be well informed before placement.
Laparoscopically monitored percutaneous endoscopic gastrostomy (PEG) in children: a safer procedure
Surgical Endoscopy, 2004
Background: Percutaneous endoscopic gastrostomy (PEG) has now become the preferred technique for facilitating enteral nutrition in children with inadequate caloric intake. Because many problems related to PEG insertion have recently been reported, we were motivated to reassess this established technique. We have therefore added a new step-laparoscopic monitoring-to the classic PEG procedure. Methods: Fifteen children who required PEG during the previous year were studied. Their ages ranged from 2 months to 18 years. Six children were < 1 year old at the time of operation. In 11 patients, the PEG was performed at the end of a laparoscopic Nissen fundoplication. In the others, it was done as a single procedure. Results: In all 15 children, the PEG was performed safely and quickly, without complications. Conclusion: The addition of 'laparoscopic monitoring' to the classic PEG procedure introduced by Gauderer et al. changes the first and last parts of the procedure from an almost 'blind' undertaking to a well-controlled and safer procedure.
Medicina, 2021
Background and Objectives: When the human body is disabled to naturally ingest food through the mouth, enteral or parenteral nutritional support should be started. Percutaneous gastrostomy (PEG) is a flexible feeding tube that is inserted into the stomach through the abdominal wall in patients who will need long-term enteral nutrient intake. The aim of this study is to analyze clinical characteristic of children at the time of PEG placement as well as to determine indications, complications and outcomes associated with PEG at the Department of Pediatrics of the University Hospital of Split. Materials and Methods: Retrospective analysis of the medical records of patients treated from 2010 to 2020 was performed. The following data were collected from medical records: age, gender, information about nasogastric feeding before PEG placement, indication for PEG insertion, duration of PEG, procedure-related complications and treatment outcomes. Malnutrition was determined according to the ...