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Outcome after percutaneous endoscopic gastrostomy in children and young adults
John E Fortunato1, April L Troy, Carmen Cuffari
1Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Preoperative dysphagia and younger age predict the need for further intervention after percutaneous endoscopic gastrostomy (PEG) in children. Neurological impairment improved weight gain post-PEG, with few major complications.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Enteral Nutrition
Background:
- Outcomes after percutaneous endoscopic gastrostomy (PEG) in pediatric populations require clearer definition.
- Predicting the need for additional interventions post-PEG is crucial for optimizing patient care.
Purpose of the Study:
- To identify preoperative clinical factors associated with outcomes following PEG in a large pediatric cohort.
- To determine predictors for the need for further interventions after PEG.
Main Methods:
- Retrospective review of 760 pediatric patients undergoing PEG from 1994-2005.
- Logistic and multiple linear regression analyses were used to assess various clinical and operative factors.
Main Results:
- Preoperative dysphagia and direct aspiration on modified barium swallow were strongly associated with fundoplication (FP) post-PEG.
- Younger age (<14 months) and dysphagia were linked to increased need for FP and longer hospital stays, respectively.
- Patients with neurological impairment showed improved weight gain post-PEG; major complications were rare.
Conclusions:
- Preoperative factors like diagnosis, indication, prematurity, and neurological status did not significantly impact postoperative complication rates.
- Dysphagia and younger age are key indicators for potential post-PEG interventions and prolonged hospitalization.
Background And Objectives:
Factors predicting outcome after percutaneous endoscopic gastrostomy (PEG) in large pediatric cohorts are not well defined. We hypothesized that definable preoperative clinical factors predict the need for further intervention to provide enteral access after PEG. Our aim was to identify factors associated with PEG outcome.
Materials And Methods:
A retrospective review of 760 (407 boys and 353 girls) patients was performed after PEG at the Johns Hopkins Children's Center from 1994 to 2005. Logistic or multiple linear regression was used to analyze indication; diagnosis; age; prematurity; neurological impairment; weight-for-age z scores; modified barium swallow; postoperative complications; need for fundoplication (FP), gastrojejunal tube, or jejunostomy; and length of hospital stay.
Results:
The median age was 1 year (range 0-26 years). The most common indications given for PEG were failure to thrive (n = 373) and dysphagia (n = 27). Postoperative FP, gastrojejunal tube, or jejunostomy were performed in 66 (10%), 24 (4%), and 9 (1%) patients, respectively. Preoperative report indicated that dysphagia and direct aspiration on modified barium swallow was strongly associated with patients undergoing FP after PEG, 10.6% of patients (P = 0.008, odds ratio 2.4) and 11.2% of patients (P = 0.013, odds ratio 2.8), respectively. Younger preoperative age was also associated with the need for FP (P = 0.0006; median age of 5.8 vs 14 months). Patients with preoperative dysphagia had a longer median length of hospital stay: 8 versus 3 days (P < 0.00001). Patients with neurological impairment demonstrated greater weight gain than neurologically normal patients after PEG (P = 0.04). Minor postoperative complications (most commonly wound infection) were observed in 4% (27/747) of children before hospital discharge from PEG and in 20% of children (138/682) after discharge. There were only 2 major complications (gastric separation and gastrocolonic fistula.). There were no fatalities.
Conclusions:
Preoperative diagnosis, indication, prematurity, and neurological impairment did not influence postoperative complications.
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