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Morbidity and mortality after percutaneous endoscopic gastrostomy in children with neurological disability

Anthony G Catto-Smith1, Susan Jimenez

  • 1Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia. tony.cattosmith@rch.org.au

Journal of Gastroenterology and Hepatology
|May 9, 2006
PubMed

Insights

Percutaneous endoscopic gastrostomy (PEG) placement aids nutrition in children with severe neurological disability. While PEG improves weight, long-term mortality is substantial but may not be directly linked to the procedure itself.

Area of Science:

  • Pediatric Gastroenterology
  • Neurology
  • Critical Care Medicine

Background:

  • Gastrostomy feeding via percutaneous endoscopic gastrostomy (PEG) is crucial for nutritional support in children with severe neurological disability.
  • The effects of PEG on gastroesophageal reflux and mortality in this population remain debated.
  • This study investigates the morbidity and long-term mortality associated with PEG in children with severe neurological disability.

Purpose of the Study:

  • To evaluate the long-term outcomes, including morbidity and mortality, of children with severe neurological disability following percutaneous endoscopic gastrostomy (PEG) placement.
  • To assess the impact of PEG on nutritional status and the incidence of gastroesophageal reflux.
  • To identify factors influencing mortality in this patient group.

Main Methods:

  • Retrospective analysis of children with severe neurological disability who underwent PEG placement at a single institution between 1990 and 1997.
  • Data collection from medical records, including demographic information, nutritional status (Z scores), incidence of reflux requiring fundoplication, and mortality.
  • Long-term follow-up of patients for 6-14 years post-PEG placement.

Main Results:

  • Ninety-eight children with severe neurological disability underwent PEG; 14 required subsequent fundoplication for reflux.
  • Patients showed initial underweight status (Z score -3.52) improving after PEG (increase of 1.05 Z score).
  • Long-term mortality rates reached 39% by 13 years; older age at PEG was associated with increased mortality (P=0.06), while reflux and initial underweight status were not significant predictors.

Conclusions:

  • Children with severe neurological dysfunction requiring gastrostomy feeding exhibit significant long-term mortality.
  • The observed mortality appears independent of the percutaneous endoscopic gastrostomy (PEG) procedure itself.
  • PEG placement can improve nutritional status in this vulnerable pediatric population.
Abstract

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