Related Experiment Videos
Percutaneous endoscopic gastrostomy in children with cancer
A M Pedersen1, K Kok, G Petersen
1Paediatric Clinic II, Juliane Marie Centre, University Hospital, Rigshospitalet, Copenhagen, Denmark.
Insights
Percutaneous endoscopic gastrostomy (PEG) feeding tubes safely improve nutrition in pediatric cancer patients, with minor complications and potential weight gain. Early consideration of PEG is recommended before malnutrition occurs.
Area of Science:
- Pediatric Oncology
- Gastroenterology
- Nutritional Support
Background:
- Malnutrition is a significant concern in children with cancer.
- Nutritional support is crucial for treatment tolerance and outcomes.
- Percutaneous endoscopic gastrostomy (PEG) offers an alternative to nasogastric feeding.
Purpose of the Study:
- To evaluate the clinical course and outcomes of PEG placement in pediatric cancer patients.
- To assess the safety and efficacy of PEG for nutritional support in this population.
Main Methods:
- Retrospective review of 32 pediatric cancer patients who received PEG.
- Analysis of clinical data including age, diagnosis, time to PEG, weight-for-age SDS, and complications.
- Assessment of outcomes including weight changes and need for tube replacement.
Main Results:
- A significant decrease in weight-for-age SDS was observed from diagnosis to PEG placement.
- No major postoperative complications occurred; most complications were minor and transient (e.g., leakage, wound infections).
- A median increase in weight SDS was noted post-PEG placement, suggesting nutritional improvement.
Conclusions:
- PEG is a safe and effective method for nutritional support in children with cancer.
- PEG offers advantages over nasogastric tubes, including cosmetic acceptability and cost-effectiveness compared to parenteral nutrition.
- Consideration of PEG before malnutrition develops is recommended, especially for patients undergoing bone marrow transplantation or intensive treatment.
Abstract:
We reviewed the clinical course of 32 children with cancer who received nutrition through a feeding tube placed percutaneously during gastroscopy (PEG). Their median age was 5.1 y (75%, range: 1.8-13.7 y, min: 3.5 mo) when the PEG was done 0.7-23 mo after diagnosis (median: 1.8 mo, 75%; range: 0.9-8 mo). Five of the children underwent bone marrow transplantation with the gastrostomy in place. There was a significant (p = 0.0001) decrease in the median weight-for-age SDS of 0.55 (75%, range: -1.18-0.28) from the time of diagnosis to placement of the gastrostomy. Twenty-two percent of the children had neutrophils < 0.5 x 10(9)l at the time of placement. There were no major postoperative complications. Seventy-two percent of the patients experienced a total of 55 minor and transient complications including leakage of gastric juice (n = 29), superficial wound infections (n = 23), mechanical problems (n = 2), or bleeding (n = 1). There were no documented cases of bacteraemia. Twelve of the wound infections (52%) arose during neutropenic episodes. Two tubes were replaced due to mechanical problems. There was a median increase in weight SDS of 0.3 (75%, range: -0.6-1.1) from the time of placing the gastrostomy to the end of follow-up (p = 0.054). Nutrition via gastrostomy in children with cancer has several advantages. It is rarely associated with more than minor complications, it is cosmetically more acceptable than the nasogastric tube and it improves nutrition at far lower cost than parenteral nutrition. In selected cases in which bone marrow transplantation or intensive treatment protocols are planned, we suggest that a gastrostomy should be considered before malnutrition develops.