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Percutaneous endoscopic gastrostomy without an antireflux procedure in neurologically disabled children
S M Borowitz1, J L Sutphen, R L Hutcheson
1Department of Pediatrics, University of Virginia, Charlottesville 22908, USA.
Insights
Percutaneous endoscopic gastrostomy (PEG) is safe for children with neurologic impairment and feeding issues. This study found PEG placement without antireflux surgery effectively managed feeding problems without significant complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neurology
Background:
- Gastrostomies are common for malnutrition and feeding difficulties in children with major neurologic impairment.
- A trend exists towards performing concurrent antireflux surgery with gastrostomy placement in this population.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous endoscopic gastrostomy (PEG) placement without antireflux surgery in children with major neurologic impairment and feeding failure.
- To assess the incidence of postoperative complications, including choking, gagging, retching, and gastroesophageal reflux.
Main Methods:
- Prospective evaluation of 19 children with major neurologic impairment and feeding failure undergoing PEG placement.
- Follow-up assessment of clinical outcomes, including feeding, respiratory symptoms, and gastroesophageal reflux.
- Parental satisfaction surveys regarding the PEG procedure.
Main Results:
- Mean age at PEG placement was 34 months, with a mean follow-up of 20.7 months.
- No patients experienced postoperative choking, gagging, or retching.
- Gastroesophageal reflux was not a significant clinical issue postoperatively.
- 95% of parents would choose PEG again, and all would recommend it.
Conclusions:
- Percutaneous endoscopic gastrostomy (PEG) placement without concurrent antireflux surgery is a safe and effective option for managing feeding difficulties in children with major neurologic impairment.
- Antireflux surgery may not be routinely necessary in all children undergoing PEG for feeding failure.
- PEG offers a high degree of parental satisfaction in this vulnerable pediatric population.
Abstract:
In children with major neurologic impairment, gastrostomies are often used to alleviate malnutrition and feeding difficulties. There has been a trend toward performing "protective" antireflux surgery in these children. Nineteen children with major neurologic impairment and feeding failure were prospectively evaluated and followed up after placement of a percutaneous endoscopic gastrostomy (PEG) without any antireflux procedure. Mean age at PEG placement was 34 months with mean follow-up of 20.7 months. All parents would recommend PEG to families with disabled children, and if given the chance, 95% would elect PEG again for their child. No child developed choking, gagging, or retching postoperatively. At the time of follow-up, postoperative gastroesophageal reflux did not appear to be a major clinical problem.