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Percutaneous endoscopic gastrostomy in small infants unable to swallow safely
Cigdem Ulukaya Durakbasa1, Sibel Hatice Ozumut2, Zeynep Nur Orhon3
1Departments of, Pediatric Surgery, Goztepe Training and Research Hospital, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey.
Insights
Percutaneous endoscopic gastrostomy (PEG) is safe for infants under 5kg, with manageable complications. Tube dislodgement is a key concern, but overall outcomes depend on underlying conditions.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Infant Nutrition
Background:
- Limited data exists on percutaneous endoscopic gastrostomy (PEG) in infants weighing ≤5 kg.
- Most existing studies focus on older pediatric populations.
Purpose of the Study:
- To evaluate the safety and outcomes of PEG placement in infants weighing ≤5 kg.
- To identify specific complications and long-term results in this unique patient group.
Main Methods:
- Retrospective analysis of medical records from January 2005 to December 2019.
- Inclusion criteria: infants ≤5 kg at the time of PEG insertion.
Main Results:
- 43 infants (mean weight 4.3 kg) underwent PEG placement.
- Successful procedures with low incidence of pneumoperitoneum (2.3%).
- Tube extrusion occurred in 14% of patients, requiring intervention. High mortality (42%) due to primary diseases.
Conclusions:
- PEG placement is a safe procedure for small infants, even with comorbidities.
- Complication rates are acceptable, with tube extrusion being a notable consideration.
- High mortality is attributed to severe underlying primary conditions, not the PEG procedure itself.
Background:
Data about percutaneous endoscopic gastrostomy (PEG) insertions in small infants are limited, and most studies include older children. We aimed to evaluate the safety of PEG placement in infants weighing ≤5 kg together with their follow-up results.
Methods:
A retrospective evaluation was made of records between January 2005 and December 2019.
Results:
A total of 43 infants were ≤5 kg at the time of PEG insertion. The mean age was 5 ± 3 (19 days-16 months) months and the mean weight was 4.3 ± 0.6 (2.7-5.0) kg. The primary diagnoses were neurological disorders in 25, metabolic disorders in nine, cleft palates in four, muscular disorders in four, and a cardiac disorder in one. All procedures were completed successfully. A self-resolving pneumoperitoneum developed in one (2.3%). The tube was extruded in six (14%) patients postoperatively which required suture-approximation of the skin and subcuticular tissues. The tube was removed in four (9%) patients with achievement of oral feeds on the long-term. Eighteen (42%) died of primary diseases. The tubes were in situ for a median of 12.4 (17 days-73 months) months in these patients. A total of 20 (46.5%) patients are currently being followed up and their tubes are in situ for a median of 50.3 (4.7 month-9.8 years) months.
Conclusions:
Percutaneous endoscopic gastrostomy placement is safe in small infants with associated morbidities. Complications related to the procedure are within acceptable limits. The accidental extrusion of the tube was a special consideration in this patient group. The overall mortality was high because of underlying primary diseases.
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