P1148* PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG): A PROMISING 10 YEARS EXPERIENCE

Abstract

Introduction: PEG has been a significant advance in the provision of nutritional support to children. The major complication rate with PEG insertion has been reported to vary from 6–54% with some life threatening complications reported in most studies. Methods: Medical records of all children who had a primary PEG insertion at Royal Aberdeen Children’s Hospital over 10 years (1993–2003) were reviewed. Results: 69 1°(primary) PEGs were inserted along with 33 2°, 22 3°, 4 4° and 3 5° PEGs in the study children. The age of the children ranged from 0.1 to 17 years (median 2). 37 children (51%) had neurological disease. 30 insertions were carried out by one gastroenterologist and 39 by four surgeons (13 at fundoplication). PEG placement was abandoned in 2 children (not included in this study) due to failed transillumiation. Follow-up ranged from 0.1 to 10.0 years (median 3.0). The rate of major complications was 11%, comprising tube dislodgement (n=3), buried bumper (n=2), severe local infection (n=2) and surgical emphysema (n=1). There were no life threatening complications. 13 children subsequently underwent fundoplication. At the end of follow-up 5 children had died, 24 were on PEG feeding, 30 were converted to a button and 13 were off tube feeding. Conclusion: Careful technique and appropriate patient selection can help minimise complications and make PEG insertion a safe procedure. There was no significant difference in the rate of complications between gastroenterologist and surgeons. Unlike adults, in children who are PEG fed, long-term survival is the norm.