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[Percutaneous endoscopic gastrostomy (PEG) in pediatric patients: our experience and proposal of follow-up
R Canali1, G Sciascia Cannizzaro, A Scaldaferri
1U.O. Chirurgia Pediatrica, Policlinico Universitario "A. Gemelli", Roma, Italia.
Insights
Percutaneous endoscopic gastrostomy (PEG) is effective for long-term enteral feeding in children, with few manageable complications. Careful follow-up and caregiver training are crucial for optimal outcomes.
Area of Science:
- Pediatric Gastroenterology
- Surgical Procedures
- Nutritional Support
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a vital intervention for pediatric patients requiring long-term enteral nutrition.
- Evaluating PEG's effectiveness and patient acceptance is essential for optimizing care protocols.
Purpose of the Study:
- To assess the efficacy and acceptability of PEG in pediatric patients.
- To establish a robust methodology for data collection and patient follow-up post-PEG placement.
Main Methods:
- An observational study (retrospective and prospective) involving 33 pediatric and 5 adult patients who underwent PEG placement using the Gauderer "push" technique.
- Data collected via questionnaire included complications, risk factors, nutritional status, management, and patient/family acceptability.
Main Results:
- PEG placement was uncomplicated; complications were minor and resolvable, with stomal dehiscence linked to larger tube gauges.
- Gastroesophageal reflux (GER) was not a contraindication, and respiratory infections decreased in patients with tracheostomies.
- Bumper removal difficulties were managed by leaving the bumper in situ with careful monitoring for obstruction.
Conclusions:
- Utilizing smaller gauge tubes minimizes dehiscence risk.
- Leaving the bumper in place is a safe option for difficult removals, provided close monitoring for gastrointestinal obstruction.
- PEG is confirmed as a preferred method for long-term enteral feeding in children, emphasizing the importance of family training and diligent follow-up.
Objective:
To evaluate effectiveness and acceptability of percutaneous endoscopic gastrostomy (PEG) in pediatric patients and to propose a data collection and follow-up methodology.
Materials And Methods:
Observational retrospective and prospective study on 33 pediatric patients and 5 adults with PEG, placed using Gauderer "push" technique, between 2000 and 2007. By means of an appropriate questionnaire, the following parameters were evaluated: complications, factors of further risk, nutritional status, management and acceptability of PEG.
Results:
No problems occurred during placement. Complications were few and easy to resolve. In 3 patients a stomal dehiscence occurred, strongly related to the tube gauge. During replacement, in 4 patients, bumper was not taken away because of difficult removal. 8 patients had pre-PEG Gastroesophageal reflux: In 2 of them, during the PEG placement, fundoplication was realized. Subsequently PEG procedure, only 1 patient needed fundoplication for worsening of GER. All of them continued gastroprotective treatment. Respiratory tract infections decreased in our 13 patients carries of tracheostomy.
Conclusions:
To prefer smaller gauge reduces risk of dehiscence. If the bumper's removal is hard, to leave it inside is acceptable and quite safe, on condition of a careful surveillance of gastrointestinal obstruction signs. GER is not a contraindication of PEG. A careful follow-up is important, by recording all the evaluated parameters and by questionnaire to the family, during every hospital admission. This study, even if on few patients, confi rms PEG as the technique of choice for long-term enteral feeding, also in children. Training of family and caregivers is important to care.
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