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Complications of removing percutaneous endoscopic gastrostomy tubes in children
G E Kobak1, D T McClenathan, S J Schurman
1Department of Pediatrics, University of South Florida College of Medicine and All Children's Hospital, St. Petersburg, USA.
Insights
Pediatric percutaneous endoscopic gastrostomy (PEG) tube removal complications are rare. Removal after 11 months increases the risk of gastrocutaneous fistula requiring surgery.
Area of Science:
- Pediatric Gastroenterology
- Surgical Complications
- Medical Device Management
Background:
- Limited data exists on complications following percutaneous endoscopic gastrostomy (PEG) tube removal in children.
- Understanding these complications is crucial for pediatric patient care.
Purpose of the Study:
- To investigate the frequency and types of complications associated with PEG tube removal in pediatric patients.
- To identify risk factors influencing complication rates.
Main Methods:
- Retrospective review of 397 pediatric patients who underwent PEG tube placement between 1993 and 1998.
- Data analysis included duration of tube placement, age at insertion, tube type, diagnosis, and post-removal complications.
Main Results:
- Of 54 children with PEG tube removal, 24% experienced persistent gastrocutaneous fistula leakage.
- Surgical closure was required in 7 children, all of whom had tubes in place for over 11 months.
- No complications requiring surgery were observed in children with tubes in place for less than 11 months.
Conclusions:
- PEG tube removal within 11 months of insertion is associated with a lower risk of gastrocutaneous fistula requiring surgical intervention.
- The duration of PEG tube placement is a significant factor in predicting the need for surgical closure of fistulas.
- This timeframe is important for clinical decision-making regarding PEG tube removal in pediatric patients.
Background:
Little information has been reported regarding the frequency and type of complications arising from removal of percutaneous endoscopic gastrostomy (PEG) tubes in children.
Methods:
The records of 397 patients who had PEG tubes placed from 1993 through 1998 were reviewed for complications after removal. Data collected included length of time the tube was in place, age of the patient at insertion, type of tube removed, and patient diagnosis.
Results:
Fifty-four children had the PEG tube removed by traction or endoscopy. The only complication was persistent leaking through a gastrocutaneous fistula in 13 patients (24%). Leaking ceased in 6 children coincident with H2-antagonist therapy and silver nitrate cautery, and surgical closure of the fistula was required in 7 patients. Comparison of these 7 children with those who did not require surgery (n = 47) showed a longer duration of tube placement (mean +/- SE of 20.6+/-3.6 months, range 11-31 months vs. 11.1+/-1.3 months, range 1-35 months; P<0.05). Further analysis showed no child with a PEG tube removed before 11 months (n = 23) after insertion required surgery, whereas 7 (23%) of 31 children with a PEG tube removed after 11 or more months required surgery. Age at insertion, type of feeding device removed, and patient diagnoses were not different between the two groups.
Conclusions:
These data indicate that persistent leaking necessitating surgical closure of a gastrocutaneous fistula does not occur in children with a PEG tube removed within 11 months of insertion. In contrast, 23% of children with a PEG tube removed 11 or more months after insertion require surgery. In patients identified as candidates for tube removal, this time frame may be important in clinical decision making.