Outcomes After Percutaneous Endoscopic Gastrostomy Insertion in Children

Abstract

Percutaneous endoscopic gastrostomy (PEG) insertion is indicated for provision of enteral nutrition when oral feeding is not possible or inadequate. The aim of this study was to review the early and late morbidity of percutaneous gastrostomy insertion in children including major and minor complications. Methods: A retrospective chart review of children who underwent percutaneous endoscopic gastrostomy by the Dept of Gastroenterology, RCH in the last 4 years was undertaken. Patient demographics, indications for gastrostomy, and the incidence of major and minor complications were recorded. Early complications were defined as those occurring within one week of insertion and late complications as those occurring after the first week. Results: 60 patient charts have been reviewed to date. The median age of insertion was 5 years (range 2months-15.5years). Indications for PEG insertion included inadequate intake (39/60, 65%), unsafe swallow or aspiration risk (19/60, 32%), and complicated metabolic requirements (2/60, 3%) in two patient's with glycogen storage disorders. Four patients (6.6%) developed major complications after insertion. Two patients developed early complications with presumed peritonitis after the procedure requiring intravenous antibiotics and gut rest. Late complications included one patient with buried bumper syndrome at the time of conversion to a skin level device 3 months after initial PEG placement. The other patient developed pneumoperitoneum on conversion to gastrostomy button. Minor complications however were common and occurred in 80% (48) of patients. Most occurred late and included granulation tissue formation (56%, 34), site infection (8%, 5), inadvertent device avulsion (8%, 5), gastric ulcer related to the gastrostomy device (1.5%,1) and skin stomal pressure ulcer (5%, 3). All patients with major complications (6.6%) were managed successfully without any surgical intervention. Patients with inadvertent tube avulsion were able to be converted easily to a skin level device and did not require any further intervention. Other minor complications were managed conservatively. All patients were still alive at 12 months follow up. Conclusions: Major complications after PEG insertion are rare and do not impact significantly on long-term patient morbidity. Minor complications however are common and usually occur late, of which granulation tissue formation is the most frequent. PEG insertion is a safe procedure in children for the provision of enteral nutrition.