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Percutaneous endoscopic gastrostomy in children and adolescents
R Behrens1, T Lang, H Muschweck
1University Children's Hospital Erlangen-Nürnberg, Germany.
Insights
Percutaneous endoscopic gastrostomy (PEG) is a safe and effective alternative to long-term nasogastric tube feeding in children. This procedure offers a significant improvement with low complication rates, even for infants.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Procedures
- Nutritional Support
Background:
- Long-term nasogastric tube feeding in children can cause hypopharyngeal irritation and tube dislocation.
- Percutaneous endoscopic gastrostomy (PEG) offers a solution to these complications.
- Experience with PEG in pediatric populations is limited compared to adults.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous endoscopic gastrostomy (PEG) in a pediatric cohort.
- To assess the range of indications and outcomes for PEG in children requiring long-term nutritional support.
Main Methods:
- A retrospective analysis of 139 pediatric patients (3 weeks to 36.5 years) undergoing PEG placement.
- Indications included central dysphagia, general dystrophy, special dietary needs, respiratory insufficiency, and gastric volvulus.
- Procedures were performed under intravenous sedation, avoiding general anesthesia.
Main Results:
- PEG was successfully placed in the stomach (n=122) or duodenum (n=15); direct jejunostomy was performed in two cases.
- Common complications included duodenal dislocation (n=5), insertion site inflammation (n=3), gastric perforation (n=2), disk disconnection (n=4), tube occlusion (n=4), and vomiting (n=1).
- The mean lifespan of a PEG tube exceeded one year.
Conclusions:
- Percutaneous endoscopic gastrostomy (PEG) significantly improves long-term tube feeding for children.
- High efficacy and low complication rates support broader consideration of PEG, including in infants.
Background:
Long-term nasogastric tube feeding is often associated with irritation of the hypopharynx or dislocation of the tube. These pitfalls may be circumvented by percutaneous endoscopic gastrostomy. Although frequently used in adults, there is limited experience with the procedure in children.
Methods:
A series of 139 patients (aged 3 weeks to 36.5 years, mean age, 4.4 years; weight 3.1-60 kg, mean weight, 15 kg) underwent placement of a percutaneous endoscopic gastrostomy because of central dysphagia (n = 103); general dystrophy caused by chronic renal failure, congenital heart disease, neoplasms, or cystic fibrosis (n = 26); requirement for special diets (n = 7); malnutrition related to respiratory insufficiency (n = 2); and gastric volvulus (n = 1).
Results:
The percutaneous endoscopic gastrostomy was placed either in the stomach (n = 122) or in the duodenum (n = 15). In two patients a direct percutaneous endoscopic jejunostomy was performed, because duodenal placement proved impossible. Percutaneous endoscopic gastrostomies were placed using intravenous sedation (midazolam, etomidate, or diazepam). None of the patients required general or inhalation anesthesia. We observed 19 complications including: dislocation of the duodenal part into the stomach (n = 5); inflammation at the insertion site (n = 3); perforation of the stomach (n = 2), which healed under conservative treatment; disconnection of the retention disk (n = 4); occlusion of the tube (n = 4), and chronic vomiting (n = 1). Mean lifetime of a percutaneous endoscopic gastrostomy was more than 1 year.
Conclusions:
Percutaneous endoscopic gastrostomy provides a major improvement for children requiring long-term tube feeding. High efficacy and low rates of complication suggest that percutaneous endoscopic gastrostomy should be considered more often, even in infants.