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Prospective determination of percutaneous endoscopic gastrostomy complication rates in children: still a safe
Benjamin D Brewster1, Brent R Weil, Alan P Ladd
1Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Insights
This study found low complication rates for percutaneous endoscopic gastrostomy (PEG) in children, suggesting it is a safe procedure. Modern PEG placement in pediatric patients demonstrates a favorable safety profile comparable to other methods.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Surgery
Background:
- Percutaneous endoscopic gastrostomy (PEG) safety in children is debated, with comparisons to laparoscopic-assisted techniques.
- Existing safety data often relies on retrospective studies and historical complication rates.
- Prospective data on modern PEG complication rates in pediatric patients is lacking.
Purpose of the Study:
- To prospectively evaluate the complication rates of percutaneous endoscopic gastrostomy (PEG) in a pediatric population.
- To establish a current understanding of the safety profile of PEG placement in children.
- To compare contemporary PEG complication rates with historical data and alternative methods.
Main Methods:
- Prospective enrollment of consecutive pediatric patients undergoing PEG placement.
- Data collection over a 90-day follow-up period post-procedure.
- Standardized interviews at 7, 30, and 90 days to record complications.
Main Results:
- 103 pediatric patients were enrolled; 92 had complete 90-day follow-up data.
- No intraoperative complications occurred; 100% procedure completion rate.
- A total complication rate of 14% was observed, with most complications being minor.
Conclusions:
- Prospective evaluation reveals low and generally minor complication rates for pediatric PEG placement.
- Observed PEG complication rates are lower than those reported in historical studies.
- The safety of modern PEG procedures in children is comparable to laparoscopic-assisted gastrostomy.
Background:
Percutaneous endoscopic gastrostomy (PEG) placement in children has come under scrutiny with reports of improved safety profiles using laparoscopic-assisted techniques. However, these reports are generally limited by their retrospective nature and the inclusion of historically determined PEG complication rates in children. Complication rates associated with PEG placement in children have not been prospectively studied, and a true modern understanding of the safety profile of PEG when performed in children is unknown. We prospectively followed children undergoing PEG to establish a clear and current understanding of the complication rates associated with this procedure.
Methods:
Consecutive PEG procedures performed between December 2009 and August 2010 at a single, tertiary-care pediatric hospital were enrolled for study. Patients were followed prospectively for 90 days with data regarding complications acquired via standardized interviews at 7, 30, and 90 days postoperatively.
Results:
We enrolled 103 patients for study. Median age and weight at time of operation was 8 months (range, 2 weeks-21 years) and 6.9 kg (range, 2-42). Patients underwent primary placement of either a PEG button (n = 70) or PEG tube (n = 33). There were no intraoperative complications, with a 100% procedure completion rate. Six deaths occurred during this follow-up time period (mean of 37 days postoperatively) and were attributed to causes other than PEG placement. Four patients were lost to follow-up. One PEG tube was electively discontinued before the end of the follow-up period without complication. Of the remaining 92 patients with complete data, 13 complications were observed in 10 patients. Total complication rate was 14%.
Conclusion:
Rates of PEG complications observed in this prospective study are low and are generally minor. Observed rates of PEG-specific complications are lower than historic reports. The safety profile of PEG when performed in today's pediatric population remains comparable in safety to techniques such as laparoscopic-assisted gastrostomy.
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