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Complications following percutaneous endoscopic gastrostomy and subsequent catheter replacement in children and young
1Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Insights
Pediatric patients with cancer and AIDS face higher risks of complications from percutaneous endoscopic gastrostomy (PEG) tube placement. Nutritional status and age do not significantly alter these risks, though rare complications can occur during PEG replacement.
Area of Science:
- Pediatric Gastroenterology
- Surgical Complications
- Medical Device Outcomes
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a common method for prolonged nutritional support in children.
- Identifying complications and risk factors associated with PEG procedures is crucial for patient safety.
Purpose of the Study:
- To determine the incidence of complications following PEG placement in pediatric patients.
- To identify risk factors, including patient demographics and underlying diagnoses, associated with PEG complications.
- To assess complications related to the replacement of PEG catheters.
Main Methods:
- Retrospective review of medical records for 137 pediatric patients undergoing PEG.
- Calculation of odds ratios to assess the association between complications and patient age, weight, weight-for-age Z score, and primary diagnosis.
Main Results:
- Overall complication rate was 12.4% (17/137), with cellulitis being the most common (7.3%).
- Patients with cancer had higher odds of wound infection; patients with AIDS had higher odds of overall complications.
- No significant association was found between age, weight, or nutritional status and adverse outcomes. PEG replacement had a low complication rate (2.4%).
Conclusions:
- Pediatric patients with cancer and AIDS are at elevated risk for PEG complications, irrespective of age, weight, or nutritional status.
- While infrequent, serious complications can arise during the replacement of PEG catheters.
Background:
Percutaneous endoscopic gastrostomy has gained wide acceptance for patients who require prolonged tube feeding support. We sought to identify complications and associated risk factors of endoscopic gastrostomy and subsequent catheter replacement in pediatric patients.
Methods:
Medical records were reviewed for 137 patients. Odds ratios were calculated for complications related to patient age, weight, weight-for-age Z score, and principal diagnosis.
Results:
Seventeen patients (12.4%) developed significant complications after gastrostomy: cellulitis occurred in 10 patients (7.3%); other complications included gastrocolic fistula (2), duodenal hematoma (1), complicated pneumoperitoneum (1), necrotizing fasciitis (1), gastric perforation (1), and catheter migration (1). Patients with cancer had significantly greater odds for developing a wound infection, and patients with AIDS had significantly greater odds for total complications. A trend toward increased wound infection was observed in patients with cardiac disease. Age, weight, and weight-for-age Z score were not associated with adverse outcome. Two complications occurred in 85 patients (2.4%) after gastrostomy catheter replacement.
Conclusions:
Pediatric patients with cancer and AIDS are at increased risk for complications after endoscopic gastrostomy regardless of age, weight, or nutritional status. Infrequent yet life-threatening complications may occur after replacement of initial gastrostomy catheter.