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Complications in children with percutaneous endoscopic gastrostomy (PEG) placement
Brigitta Balogh1, Tamás Kovács2, Amulya Kumar Saxena3
1Division of Pediatric Surgery, Department of Pediatrics, University of Szeged, Korányi fasor 14-15, Szeged, 6725, Hungary. dr.balogh.brigitta@hotmail.hu.
Insights
Percutaneous endoscopic gastrostomy (PEG) is a safe procedure with low severe complication rates, though minor issues occur in one-third of patients. Laparoscopic-assisted PEG is recommended for high-risk children, especially those with VP shunts.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Devices
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a common procedure for nutritional support in children.
- Analysis of PEG complications, mortality, indications, and risk factors is crucial for optimizing patient outcomes.
- Understanding the impact of operative techniques and comorbidities on PEG safety is essential.
Purpose of the Study:
- To analyze complication and mortality rates associated with various percutaneous endoscopic gastrostomy (PEG) operative techniques in children.
- To evaluate the influence of patient age, underlying diseases, and other risk factors on PEG outcomes.
- To assess the indications for PEG insertion and associated comorbidities.
Main Methods:
- A literature analysis of percutaneous endoscopic gastrostomy (PEG) related complications in children was conducted.
- PubMed database was searched for relevant articles published between 1994 and 2017.
- Keywords used included "percutaneous endoscopic gastrostomy", "complications", "mortality", and "children".
Main Results:
- Eighteen articles involving 4631 pediatric patients were analyzed, with a mean age of 3 years.
- Minor complications occurred in 33% of patients (e.g., granulation, local infection, leakage), while major complications occurred in 10% (e.g., systemic infection, cellulitis).
- Laparoscopic-assisted PEG showed fewer major/severe complications than the pull technique in high-risk patients, including those with ventriculoperitoneal (VP) shunts.
Conclusions:
- Percutaneous endoscopic gastrostomy (PEG) is a safe procedure with a low rate of severe complications, despite common minor complications.
- Comorbidities are prevalent in PEG patients, and the presence of a ventriculoperitoneal (VP) shunt increases the risk of major complications.
- Laparoscopic-assisted PEG is recommended over the traditional pull technique for high-risk pediatric patients.
Introduction:
The aim of this study was to analyze the complication rates and mortality in association with different operative techniques of percutaneous endoscopic gastrostomy (PEG), age, underlying diseases and other risk factors. Moreover, analysis of the indications of PEG insertion and the underlying comorbidities was also performed.
Methods:
This study performs a literature analysis of PEG-related complications in children. Literature was searched on PubMed® (1994-2017) using terms "percutaneous endoscopic gastrostomy", "complications", "mortality" and "children".
Results:
Eighteen articles with 4631 patients were analyzed. The mean age was 3 years (0-26 years). Operative techniques were: pull technique in 3507 (75.7%), 1 stage PEG insertion in 449 (9.7%), introducer technique in 435 (9.4%), image-guided technique in 195 (4.2%) and laparoscopic-assisted PEG in 45 (1.6%). Most frequent indications for PEG insertion were dysphagia (n = 859, 32.6%), failure to thrive (n = 723, 27.5%) and feeding difficulties (n = 459,17.4%). Minor complications developed in n1518 patients (33%), including granulation (n = 478, 10.3%), local infection (n = 384, 8.3%) and leakage (n = 279, 6%). In 464 (10%) patients, major complications occurred; the most common were systemic infection (n = 163, 3.5%) and cellulitis (n = 47, 1%). Severe complication like perforation occurred in less than 0.3%. Patients with lethal outcomes (n = 7, 0.15%) had severe comorbidities; and the cause of mortality was sepsis in all cases. Prematurity or young age did not affect complication rate. Patients with ventriculoperitoneal (VP) shunt had higher risk of major complications. In high-risk patients, laparoscopic-assisted PEG insertion had less major and severe complication than traditional pull technique.
Conclusions:
PEG is a safe operative technique; although minor complications are relatively common and occur in up to 1/3 of patients, there is a fairly low rate of severe complications. Two-thirds of PEG patients have at least one comorbidity. Patients with VP shunt have higher risk of major complications. In high-risk patients, laparoscopic-assisted PEG is recommended.
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