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Feasibility of percutaneous endoscopic gastrostomy insertion in children receiving peritoneal dialysis
Caroline Kempf1, Johannes Holle1, Susanne Berns1
1Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité - University Medicine Berlin, Germany.
Insights
Prophylactic antibiotics and antifungals, along with adjusted peritoneal dialysis (PD), can lower peritonitis risk in children undergoing percutaneous endoscopic gastrostomy (PEG) tube placement. This approach supports safe feeding in pediatric end-stage kidney disease patients on PD.
Area of Science:
- Pediatric Nephrology
- Gastroenterology
- Surgical Procedures
Background:
- Peritoneal dialysis (PD) is the primary dialysis method for pediatric end-stage kidney disease.
- Malnutrition is common in these patients, often managed with percutaneous endoscopic gastrostomy (PEG) tubes.
- Concerns exist regarding peritonitis risk following PEG placement in PD patients, with limited data on preventative strategies.
Purpose of the Study:
- To evaluate the safety of PEG insertion in pediatric PD patients.
- To assess the effectiveness of prophylactic antibiotics, antifungals, and PD program modifications in preventing peritonitis.
Main Methods:
- A single-center analysis of pediatric PD patients who underwent PEG placement between 2015 and 2020.
- Data collected included patient demographics, peri-interventional prophylactic antibiotic/antifungal treatment, and PD program adjustments.
- Peritonitis incidence within 28 days post-PEG insertion was calculated.
Main Results:
- Eight pediatric PD patients (median weight 6.7 kg) received PEG insertion.
- Prophylactic antibiotics and antifungals were administered for median durations of 4.0 and 5.0 days, respectively.
- Following PD program adjustments, all patients resumed regular PD within a median of 6 days, with only one case of peritonitis occurring within 24 hours of PEG insertion.
Conclusions:
- A prophylactic antibiotic and antifungal regimen, combined with an adapted PD program, appears to effectively reduce peritonitis risk in pediatric PD patients undergoing PEG procedures.
- This combined approach supports the safe use of PEG for nutritional support in this vulnerable population.
Background:
Peritoneal dialysis (PD) is the preferred dialysis modality for paediatric patients with end-stage kidney disease. Frequently, malnutrition is encountered. Percutaneous endoscopic gastrostomy (PEG) is the preferred mode of feeding because of its minimal invasive mode of placement and easy handling in daily life. However, reports of a high risk for early post-interventional peritonitis hampered this procedure during PD and controlled studies on the benefit of peri-interventional management to prevent peritonitis are lacking. Here, we report the safety profile of PEG insertion among a cohort of children on PD by using a prophylactic antibiotic and antifungal regimen as well as modification of the PD programme.
Methods:
We performed a single-centre analysis of paediatric PD patients receiving PEG placement between 2015 and 2020. Demographic data, peri-interventional prophylactic antibiotic and antifungal treatment as well as modification of the PD programme were gathered and the incidence of peritonitis within a period of 28 days after PEG was calculated.
Results:
Eight PD patients (median weight 6.7 kg) received PEG insertion. Antibiotic and antifungal prophylaxis were prescribed for median time of 4.0 and 5.0 days, respectively. After individual reduction of PD intensity, all patients continued their regular PD programme after a median of 6 days. One patient developed peritonitis within 24 h after PEG insertion and simultaneous surgery for hydrocele.
Conclusions:
Applying an antibiotic and antifungal prophylactic regime as well as an adapted PD programme may reduce the risk for peritonitis in paediatric PD patients who receive PEG procedure.
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