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Safety and efficacy of percutaneous endoscopic gastrostomy in children
O E Marin1, M S Glassman, B T Schoen
1Emory University School of Medicine, Division of Pediatric Gastroenterology and Nutrition, Atlanta, Georgia.
Insights
Percutaneous endoscopic gastrostomy (PEG) placement is safe and effective for pediatric nutritional support, especially for conditions like cystic fibrosis. However, children with multi-system organ failure face higher complication risks, potentially outweighing benefits.
Area of Science:
- Pediatric Gastroenterology
- Surgical Nutrition
- Medical Device Efficacy
Background:
- Nutritional support is critical for pediatric patients with feeding difficulties.
- Percutaneous endoscopic gastrostomy (PEG) offers a minimally invasive route for enteral feeding.
Purpose of the Study:
- To evaluate the safety and efficacy of PEG placement in children for nutritional support.
- To identify patient populations that benefit most and those at higher risk.
Main Methods:
- Retrospective chart review of 70 pediatric patients undergoing PEG placement (1989-1992).
- Comparison of pre- and post-procedure weight Z-scores.
- Incidence assessment of major and minor complications.
Main Results:
- 70% of patients showed improved nutritional status post-PEG.
- Congenital heart disease (86%) and cystic fibrosis (80%) patients showed significant benefit.
- Major complications occurred in 19% of patients, with a significantly higher rate (p < 0.001) in those with multi-system organ failure.
Conclusions:
- PEG placement is a safe and effective nutritional support method for children without multi-system organ failure.
- Children with multi-system organ failure experience increased complications and poorer outcomes, suggesting caution in their use of PEG.
Objectives:
To establish the safety and efficacy of percutaneous endoscopic gastrostomy (PEG) placement for nutritional support in children.
Methods:
The charts of 70 children who underwent the procedure between 1989 and 1992 were reviewed. Three of the 70 had repeat PEG placement. Patients ranged in age from 3 months to 24 yr, and included 28 females and 42 males. In all patients, the weights at the time of insertion of the PEG, and in 64, weight after 6 months of nutritional support, were compared by Z-score, and the incidence of major and minor complications was determined.
Results:
Forty-five of 70 patients (70%) had improved nutritional status after initiation of PEG feedings, and in three (4%), the weight was maintained despite limited oral intake. Patients with congenital heart disease (86%) and cystic fibrosis (80%) derived the greatest benefit from the enteral feedings. Major complications were noted in 13 (19%) patients and minor complications in 16 (22%). Nine of 13 (70%) major complications and four of 116 (25%) minor complications occurred in the 12 (17%) children with multi-system organ failure. The rate of major complication was significantly greater in children with multi-system organ failure than in all patients (p < 0.001) and their relative risk of complication was increased by a factor of 40.
Conclusions:
Our data indicate that PEG is a safe and effective modality for nutritional support in children without multi-system organ failure. Those with multi-system organ failure have an increased rate of complications and a poor response to nutritional support, suggesting that the risk of PEG may outweigh its benefit for this population.