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[Percutaneous endoscopic gastrostomy (PEG) in children: indications, the procedure, outcomes, short and long-term
Rona Eger1, Shimon Reif, Ayala Yaron
1Schneider Center for Childrens' Medicine, Dana Hospital for Children. rona_lev@walla.co.il
Insights
Percutaneous endoscopic gastrostomy (PEG) is a safe and effective method for providing nutritional support in children. This minimally invasive procedure has a high success rate and a low incidence of severe complications, making it ideal for pediatric patients requiring enteral nutrition.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Procedures
- Nutritional Support
Context:
- Enteral nutrition is crucial for children unable to eat due to various medical conditions.
- Surgical gastrostomy was the traditional method, but percutaneous endoscopic gastrostomy (PEG) has become more prevalent.
- PEG offers a less invasive alternative for long-term nutritional support.
Purpose:
- To evaluate the indications, outcomes, and complications of PEG in a pediatric population.
- To assess the effectiveness of PEG in children requiring enteral nutrition.
- To compare complication rates based on the medical professionals performing the procedure.
Summary:
- A retrospective study of 52 children undergoing PEG procedures at two medical centers.
- Common indications included failure to thrive and neurological disorders.
- Procedures performed by gastroenterologists alone showed lower complication rates (20.8%) compared to those involving surgeons (52.6%).
- Ninety-six percent of procedures were successful, with most complications being minor.
Impact:
- PEG is a minimally invasive technique with a low rate of severe complications in children.
- It provides essential nutritional support for pediatric patients.
- The findings support the use of PEG as a primary method for enteral feeding in children.
Background:
Feeding through tubes placed in the intestine is a useful way of nutritional support in a patient who is unable to eat but has a well functioning gastrointestinal system. Till 1980, the acceptable technique to place a gastrostomy tube was surgical. However, in the past twenty years percutaneous endoscopic gastrostomy (PEG) has replaced surgical gastrostomy in most settings.
Goals:
In this study we explored the indications, the age of the patients, the conditions in which the procedure took place and its outcome in children. The study aimed to investigate the effectiveness of this method in children.
Methods:
The data was gathered retrospectively according to information found in the files and a questionnaire the parents answered. Fifty-two children from the Tel Aviv Medical Center and from the Sheba Medical Center who underwent a PEG procedure were studied. The data gathered from the study included age, gender, origin, sequence of the procedure, indications, place, performers, complications and the effectiveness of the method according to parents' satisfaction and weight of the patient. In addition, the following parameters were studied: type of anesthesia, sort of antibiotics that were provided, number of cases in which enteral nutrition was given permanently or temporarily, type of formula that was given and the way it was introduced, number of failures and fundoplications.
Results:
Mean age of the children was 5.4 years. Ninety six percent of the procedures succeeded. The most common indications were failure to thrive (35%) and neurological disorders. In 56% of cases the performer was a gastroenterologist alone. When the procedures were performed by gastroenterologists, a lower rate of complications was seen than with a gastroenterologist and a surgeon (20.8% vs. 52.6% accordingly). In 57% of the children there were no complications observed. In addition, most of the complications which were observed were minor (abdominal pain, nausea and vomiting and reflux).
Conclusions:
According to this study we concluded that PEG is a minimally invasive technique, associated with a low rate of severe complications and provides significant support for children who need enteral nutrition.
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