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Late-onset complications of percutaneous endoscopic gastrostomy in children
D Ségal1, L Michaud, D Guimber
1Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille Faculty of Medicine and Children's Hospital, Lille, France.
Insights
Percutaneous endoscopic gastrostomy (PEG) in children leads to significant late complications, primarily within two years post-insertion. This study found no identifiable clinical risk factors for these complications, highlighting the need for continued monitoring.
Area of Science:
- Pediatric Gastroenterology
- Surgical Complications
- Medical Device Safety
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a common procedure for enteral nutrition in pediatric patients.
- While generally safe, late-onset complications can impact patient outcomes and require careful management.
- Understanding the incidence and nature of these complications is crucial for improving patient care.
Purpose of the Study:
- To document the frequency and types of late-onset complications following PEG insertion in children.
- To investigate potential clinical risk factors associated with the development of these complications.
- To provide insights into the long-term safety profile of PEG in a pediatric population.
Main Methods:
- A retrospective analysis of 110 pediatric patients who underwent PEG insertion using the pull technique.
- Follow-up ranged from 1 to 8 years, recording complications occurring more than 6 days post-insertion (excluding tube obstruction/dislodgement).
- Statistical tests (Wilcoxon, chi-square) were employed to identify potential risk factors by comparing patient characteristics and device materials.
Main Results:
- The overall rate of late-onset complications was 44%, with 75% occurring within the first two years.
- Intragastric buried or extruded gastrostomy was the most frequent complication (n=24).
- No specific clinical risk factors were identified, although one type of button device was associated with higher rates of buried gastrostomy compared to tubes.
Conclusions:
- PEG insertion in children is associated with considerable late morbidity, predominantly within the initial two years.
- Despite the observed complications, this study could not identify any specific clinical risk factors.
- Further research may be needed to elucidate potential contributing factors and optimize PEG safety in pediatric patients.
Purpose:
The aim of this study was to report the late morbidity of percutaneous endoscopic gastrostomy (PEG) in a pediatric population and to identify possible risk factors for complications developing after PEG insertion.
Methods:
A PEG was placed in 110 children between 1 May 1990 and 1 January 1997 using the pull technique. A retrospective study of late-onset complications was performed, with a follow-up period ranging from 1 to 8 years. All the complications occurring more than 6 days after PEG insertion were recorded, except for gastrostomy tube obstruction and accidental tube dislodgement.
Results:
The prevalence of late-onset complications related to PEG in our patients varied from 3.8 to 4.4 per 10 5 days. The overall rate of late-onset complications was 44% (48 complications observed in 29 patients [26%]). Seventy-five percent of the complications appeared during the first 2 years after PEG insertion. Nine different types of complication have been identified: intragastric buried or extruded gastrostomy (n = 24), gastric metaplasia granulation tissue around the site of gastrostomy (n = 8), intragastric pseudotumoral proliferative gastric mucosa (n = 4), intragastric mucosal ulceration (n = 3), cutaneous necrosis (n = 3), cologastric fistula (n = 2), gastrostomy closure delay after tube removal (n = 2), subcostal neuralgia (n = 1), and peritonitis (n = 1). Wilcoxon and chi-square tests were used to compare the clinical characteristics of the patients and the type of material used in the two populations, with and without complications. No clinical risk factor for the development of complications could be identified. Intragastric buried or extruded gastrostomy appeared more frequently with the use of one type of button than with the use of tubes.
Conclusions:
The authors' experience suggests that PEG is associated with significant late morbidity, which is mainly observed within the first 2 years after PEG insertion. However, no risk factor for the development of such complications could be identified.