Complication Of Gastrostomy Research Articles

Is it Cellulitis Again? Erythema Concerning for Infection in Children With High-Risk Solid Tumors Who Have a Gastrostomy Tube.

Proper nutrition is known to hasten healing, reduce treatment-related morbidity, and improve outcomes. Children with high-risk solid tumors often have gastrostomy tubes (GTs) placed for supplemental nutrition during cancer therapy. Gastrostomy tubes, however, are not without risks, and many patients develop erythema concerning for infection at the stoma site. Gastrostomy complications are described in the literature, but knowledge regarding this topic is limited. In this retrospective descriptive study, the authors reviewed 3 years of clinical data regarding pediatric patients with solid tumors who had GTs at a pediatric medical center. Descriptive statistics were used to describe the incidence of erythema concerning for infection, identify factors most likely to be associated with this complication, and understand how erythema impacts the completion of cancer therapy. In a sample of 58 children with high-risk solid tumors who had GTs placed between 2018 and 2021, 53% developed erythema concerning for infection. More subjects who experienced episodes of GT erythema had neuroblastoma (48%), tubes placed after the start of cancer therapy (74%), and erythema during periods of neutropenia (71%). Only one subject experienced a treatment delay due to GT erythema. Despite the rate of GT erythema among study subjects, most completed cancer therapy without delay related to this complication. Additionally, the incidence of stoma site erythema was notably less when tubes were placed prior to the start of cancer therapy. Therefore, the authors recommend GT placement prior to therapy start when possible and further attention be paid to this complication during cancer therapy.

Surgical technique-related complications of pediatric gastrostomy

IntroductionGastrostomy is a commonly performed procedure in pediatric patients, with various surgical techniques available for its application. However, no consensus exists regarding the optimal technique. This study aims to evaluate the outcomes and complications associated with different surgical techniques used for gastrostomy in children. MethodsThis retrospective cohort study involved a review of medical records from patients who underwent gastrostomy using any of the four techniques employed at Fundación HOMI. A statistical analysis was conducted to determine the correlation between surgical technique and the occurrence of early and late complications. ResultsA total of 350 patients were included in the study, with a mean age of 47.3 months (SD: 3 months). The open technique was utilized in 43.3 % of cases, endoscopic in 31.7 %, Laparoscopic-assisted percutaneous endoscopic gastrostomy in 12.6 %, and laparoscopic in 12.3 %. Early complications were observed in 27.1 % of patients, while late complications occurred in 24.86 % of cases. No correlation was found between the occurrence of complications and patient age, comorbidities, surgical indication, additional procedures performed during gastrostomy, or surgeon experience. However, laparoscopic gastrostomy was significantly correlated with peristomal leakage (p = 0.0002). We conducted long-term (at least three months) postoperative follow-up of 247 patients. ConclusionsThis study highlights a significant correlation between laparoscopic gastrostomy and peristomal leakage. However, no standard or preferred technique for performing gastrostomy in children has been identified.

How far is the endoscopist to blame for a percutaneous endoscopic gastrostomy complication?

Percutaneous endoscopic gastrostomy (PEG) is a well-established, minimally invasive, and easy to perform procedure for nutrition delivery, applied to individuals unable to swallow for various reasons. PEG has a high technical success rate of insertion between 95% and 100% in experienced hands, but varying complication rates ranging from 0.4% to 22.5% of cases. To discuss the existing evidence of major procedural complications in PEG, mainly focusing on those that could probably have been avoided, had the endoscopist been more experienced, or less self-confident in relation to the basic safety rules for PEG performance. After a thorough research of the international literature of a period of more than 30 years of published "case reports" concerning such complications, we critically analyzed only those complications which were considered - after assessment by two experts in PEG performance working separately - to be directly related to a form of malpractice by the endoscopist. Malpractice by the endoscopist were considered cases of: Gastrostomy tubes passed through the colon or though the left lateral liver lobe, bleeding after puncture injury of large vessels of the stomach or the peritoneum, peritonitis after viscera damage, and injuries of the esophagus, spleen, and pancreas. For a safe PEG insertion, the overfilling of the stomach and small bowel with air should be avoided, the clinician should check thoroughly for the proper trans-illumination of the light source of the endoscope through the abdominal wall and ensure endoscopically visible imprint of finger palpation on the skin at the center of the site of maximum illumination, and finally, the physician should be more alert with obese patients and those with previous abdominal surgery.

Complications of Percutaneous Radiologic Gastrostomy Among Patients in a Tertiary Care Hospital in Riyadh, Saudi Arabia.

Percutaneous radiologic gastrostomy (PRG) is the method of choice for patients incapable of ingesting nutrition orally. The complications related to PRG are classified into major and minor complications. This article presents the prevalence of major and minor complications of PRG among adult patients admitted to King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia between 2017 and 2018. This was a retrospective cross-sectional study, which included adult patients who underwent a new PRG intubation between 2017 and 2018 in KAMC in Riyadh, Saudi Arabia. The variables reviewed were the demographics, comorbidities, indications of tube insertion, major and minor complications, and mortality rates. A total of 105 patients who underwent PRG were covered in this study with a mean age of 69.2 + 20.4 years. The most common indications were neurogenic pharyngeal dysphagia (31%) and dementia (29%). Most of the complications reported were minor (40%)and major complications were found in 2%. The percentage of patients with both minor and major complications was 37%. The patients who had no complications made up 21%. Major skin complication was reported in 19 patients (18%), while leakage was the most occurring minor complication found in 49 patients (47%). The 30-day mortality was observed in five patients (5%) and one-year mortality was observed in 21 patients (20%), and none of them were related to the PRG tube. This study found that the PRG procedure had low rates of complications in KAMC. The majority wereminor complications, and the mortality rate was low with none being related to the tube itself. So PRG may be considered to be a relatively safe procedure.

Risk factors for adverse outcomes of percutaneous endoscopic gastrostomy

Introduction. Presently, percutaneous endoscopic gastrostomy is considered to be the operation of choice when long-term enteral feeding in dysphagia syndrome is required. The technique is characterized by low incidence of early and long-term complications due to low traumatic access and operation time. Aim of the work was to assess the risk predictors of percutaneous endoscopic gastrostomy complications and their significance for the postoperative period. Materials and methods. We searched publications and analyzed literature sources using PubMed and MedLine databases and Cochrane Library and elibrary.ru scientific libraries mainly for the last ten years. The search was performed using a set of key words: percutaneous endoscopic gastrostomy, dysphagia syndrome, postoperative complications, risk factors. Results and discussion. The leading and most studied predictors of early and long-term postoperative period complications after gastrostomy are hypoalbuminemia, uncompensated diabetes mellitus, thrombocytopenia, elevated levels of C-reactive protein, Charlson's comorbidity index (4 points or higher), antiaggregant and anticoagulant therapy, morphoconstitutional features of patients. Conclusion. Data analysis has shown that percutaneous endoscopic gastrostomy at high patient flow and gastropectomy supplementation with gastropexy is practically safe and effective if the selection criteria for the operation are observed taking into account the general condition, risk factors and exclusion of absolute contraindications.

Complications and outcomes of gastrostomy versus nasogastric tube feeding in paediatric allogeneic bone marrow transplant: A prospective cohort study

The intensive conditioning regimens administered during bone marrow transplant (BMT) frequently cause mucositis, gastrointestinal toxicity and reduced oral intake. Children are consequently at risk of malnutrition. First-line nutrition support is recommended as enteral nutrition (EN). Nasogastric tube (NGT) is the mainstay for administration. Gastrostomies provide an alternative, but there is limited evidence of their efficacy and safety in paediatric BMT. This study aimed to compare enteral tube complications and nutritional and clinical outcomes between children with a gastrostomy versus NGT throughout BMT. A prospective cohort study was conducted at a single centre in the United Kingdom. During pre-admission consultations families were offered choice of a prophylactic gastrostomy or NGT. Children undergoing allogeneic BMT were recruited from April 2021 to April 2022. Data compared between children with either tube included: tube complications, change in weight, body mass index and mid-upper-arm circumference, calorie, protein and fluid intake, timing and use of EN and parenteral nutrition, survival, graft-versus-host disease and length of admission. Following BMT, data were collected weekly for the first six weeks from electronic records, monthly thereafter from 3-day averaged food diaries and clinic assessments, until six months post-BMT. Nineteen children with NGT were compared to 24 with a gastrostomy. Of gastrostomy complications, 94.2% (129/137) were minor, mechanical issues being most common (80/137). Dislodgement comprised 80.2% (109/136) of NGT complications. No significant differences were seen between tubes on nutritional, anthropometric and clinical outcomes. Gastrostomies were popular with families, relatively safe, associated with mostly minor complications and similarly effective as NGTs in supporting children's nutritional intake and status. Where an NGT may not be tolerated, a prophylactic gastrostomy could be considered. Placement of either tube requires balancing their risks, benefits, the child's nutritional status, conditioning, expected duration of EN and family preferences.

Complications of percutaneous endoscopic gastrostomy in intensive care patients with dysphagia associated with neurological disorders

To develop an effective method for percutaneous endoscopic gastrostomy using gastropexy technology. We retrospectively analyzed 260 ICU patients with dysphagia associated with neurological disorders between 2010 and 2020. All patients were divided into two groups: the main group (n=50) - percutaneous endoscopic gastrostomy with gastropexy, control group (n=210) - surgery without fixing the anterior wall of the stomach to the abdominal wall. Astropexy significantly reduced the incidence of postoperative complications (p=0.045) and severe complications (grade IIIa and higher) (χ2=3.701, p=0.055). Early postoperative complications occurred in 20 (7.7%) patients. Surgery and subsequent treatment were associated with normalization of leukocyte count (p=0.041), C-reactive protein (p=0.024) and serum albumin (p=0.0012). Mortality was similar in both groups. Overall 30-day mortality rate in both groups was 20.8% that was associated with clinical severity of patients. Percutaneous endoscopic gastrostomy was not the direct cause of death in any case. However, complications of endoscopic gastrostomy aggravated the underlying disease in 2.9% of cases. Percutaneous endoscopic gastrostomy with gastropexy reduces the incidence of postoperative complications.

S592 Outcomes and Complications of Radiologic Gastrostomy vs Percutaneous Endoscopic Gastrostomy for Enteral Feeding - An Updated Systematic Review and Meta-Analysis

S592 Outcomes and Complications of Radiologic Gastrostomy vs Percutaneous Endoscopic Gastrostomy for Enteral Feeding - An Updated Systematic Review and Meta-Analysis

Radiologically inserted gastrostomy complications: A case series

Radiologically inserted gastrostomy complications: A case series

Gastrostomy-related gastric outlet obstruction

Patients with cerebral palsy (CP) would result in movement and postural limitations and involuntary convulsion caused gastroesophageal reflux (GERD), which mostly requires Nissen fundoplication treatment. However, gastric outlet obstruction, a rare complication of gastrostomy, might also cause GERD and feeding difficulty secondary to delay gastric emptying. Herein, we presented an 11-year-old male with a history of CP who was admitted to our hospital by acute kidney injury (AKI) due to poor intake, which was initial diagnosis as GERD secondary to involuntary muscle spasms resulting from CP. However, the final diagnosis turned out to be gastrostomy-related outlet obstruction. The primary purpose of this report was for physicians to consider this diagnosis when facing a patient with cerebral palsy and gastrostomy history who had clinical features of feeding difficulty and GERD.

Reevaluation of the Merits and Demerits of Prophylactic Gastrostomy in Patients with Head and Neck Cancer Undergoing Concurrent Chemoradiotherapy

AbstractConcurrent chemoradiotherapy (CCRT) is one of the standard treatment strategies for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Prophylactic percutaneous gastrostomy (pPEG) has been reported to be useful for nutritional intervention during CCRT. On the other hand, disadvantages such as complications of gastrostomy itself and long-term PEG dependence have also been reported. In the present study, we conducted a retrospective review of the data of HNSCC cases treated with CCRT and reevaluate the merit and demerit of pPEG. Patients with pharyngeal carcinoma treated by CCRT between 2015 and 2020 were enrolled for this analysis. In this study, we limited our analysis to those who received the following treatments: Radiation therapy was planned for a total dose of 70 Gy, and the concomitant chemotherapy regimen was high-dose (100 mg/m2) CDDP administered intravenously once every three weeks (three cycles). A total of 54 patients who underwent pPEG met the inclusion criteria. Fifteen patients who had received similar treatment without pPEG during the study period were used as a control group for comparison. The results revealed that in the pPEG group, there were fewer cases with a weight loss of 10% or more, nutritional intervention was started relatively early, and the hospitalization period after the end of CCRT was shorter as compared with the status in the non-PEG group. In regard to PEG tube dependence, the rate of PEG tube usage at 6 months after CCRT was relatively low, at approximately 13%. No significant factor was identified in this study regarding the need for nutritional intervention by routes, including PEG tube, nasogastric tube, and total parenteral nutrition, other than oral intake. In the review of the literature, it seemed difficult to make a simple comparison due to the lack of uniformity in the selection criteria for pPEG, patient background, and treatment intensity.

Managing complications of percutaneous tracheostomy and gastrostomy.

Percutaneous tracheostomy and gastrostomy are some of the most commonly performed procedures at bedside in the intensive care unit. While they are generally considered safe, they can be associated with numerous short and long-term complications, many of which can occur long after their placement and cause significant morbidity. Performers of these procedures should possess a comprehensive understanding of procedural indications and contraindications, and know how to recognize and manage complications that may arise. In this review, we highlight complications of percutaneous tracheostomy and describe strategies for their prevention and management, with a special focus on post-tracheostomy tracheal stenosis. Other complications reviewed include bleeding, pneumothorax and subcutaneous emphysema, posterior wall injury, tube displacement, tracheomalacia, tracheoinominate artery fistula, tracheo-esophageal fistula, and stomal cellulitis. Gastrostomy complications and their management are also discussed including bleeding, internal organ injury, necrotizing fasciitis, aspiration pneumonia, buried bumper syndrome, tumor seeding, wound infection, tube displacement, peristomal leakage, and gastric outlet obstruction. In light of the potentially serious outcomes associated with complications of percutaneous tracheostomy and gastrostomy, the emphasis should be placed on risk-reduction strategies to minimize morbidity and mortality. We therefore present detailed pragmatic and comprehensive checklists to serve as a reference for clinicians involved in performing these procedures.

Systematic review of gastrostomy complications and outcomes in pediatric cancer and bone marrow transplant

Nutrition support is essential in children with cancer, including those undergoing bone marrow transplant (BMT), to reduce the risk of malnutrition and associated deleterious outcomes. Enteral nutrition is more commonly provided via nasogastric than gastrostomy tubes because of safety concerns with the latter in immunocompromised children. This systematic review investigated the incidence and type of complications and outcomes in pediatric cancer patients fed by gastrostomy. Databases were searched for randomized and observational studies investigating the use of any gastrostomy device in children aged <18 years with any cancer diagnosis, including those undergoing BMT. Five cohort and 11 case series studies were included. Owing to clinical heterogeneity, meta-analyses were not performed. Quality of evidence varied, with five studies judged at serious risk of bias and poor quality; however, the remaining 11 were considered to range from moderate to good quality. Across studies, 54.6% of children developed one or more complications, of which 76.6% were classified as minor, 23.4% major. The most frequent complications included inflammation (52% of episodes), infection (42.1%), leakage (22.3%), and granuloma (21%). Evidence regarding infection rates in cancer/BMT patients compared with other disease states was inconclusive. Gastrostomy feeding was associated with improvement or stabilization of nutrition status in 77%-92.7% of children. Gastrostomy feeding in this population is relatively safe and effective in stabilizing or improving nutrition status throughout treatment. Complications are frequent but mostly minor. Placement requires careful consideration of the complications, benefits, nutrition risk and status at diagnosis, and quality of life.

Long-Term Analysis of Respiratory-Related Complications Following Gastrostomy Placement with or without Fundoplication in Neurologically Impaired Children: A Retrospective Cohort Study.

Gastrostomy placement is crucial in neurologically impaired (NI) children to ensure an adequate food intake and a safe route for drugs administration and to reduce the risk of primary aspiration. NI patents are more prone to gastroesophageal reflux. The association with fundoplication is deemed to reduce reflux-related respiratory complications. However, long-term benefits of this approach are not clear. We therefore aimed to compare long-term reflux-related respiratory complications of gastrostomy only (GO) to gastrostomy with fundoplication (GF). We retrospectively reviewed 145 consecutive NI children managed from 2008 to 2018. As long-term outcomes, we analyzed number and length of hospital admissions (Reflux-Related-Hospitalization, RRH) and emergency department accesses (Reflux-Related-Accesses, RRA) due to respiratory problems. Results were analyzed with appropriate statistical method. Median age at referral and at gastrostomy placement were 2.2 and 3.4 years (SD 5.6), respectively. Median follow-up was four years (range 1–12). Anti-reflux procedures were performed in 26/145 patients (18%); tracheotomy in 23/145 (16%). RRH following surgery showed lower number of admissions/year (0.32 vs. 1 for GO vs. GF, p < 0.005) and days hospitalization/year (3 vs. 13, p = 0.08) in GO compared to GF; RRA was similar (0.60 vs. 0.65, p = 0.43). Gastrostomy placement alone appeared not to be inferior to gastrostomy plus fundoplication with respect to long-term respiratory-related outcomes for NI children in our center.

Emergency Presentations for Gastrostomy Complications Are Similar in Adults and Children.

Gastrostomy tube (GT) complications are often managed in the Emergency Department (ED). We aimed to characterize and compare the pattern of ED presentations of GT complications in adults and children. A retrospective chart review of patients with GT complications presenting to 3 Australian EDs in 2 years was undertaken. ED visits for GT complications occurred in 70 GT patients (36 adults, 34 children) with 122 presentations. When comparing adults to children, infections occurred in 21% versus 36%, respectively; P = 0.08, mechanical issues in 48% versus 52%; P = 0.86, vomiting in 23% versus 8%; P = 0.02, and other issues in 7% versus 5%; P = 0.7. Presentation to ED within 28 days of initial GT insertion occurred in 3 (8%) adults and 3 (9%) children, predominantly with tube dislodgement. GT complications seen in ED are predominantly infectious and mechanical in nature, with an increased frequency of vomiting in adults when compared with children.

Percutaneous Image-guided Gastrostomy Insertion with and without Gastropexy

Purpose: The objective was to compare the major and minor complications of percutaneous gastrostomy with and without gastropexy. Materials and Methods: This was a retrospective study of adult patients who underwent percutaneous gastrostomy with or without gastropexy between January 2015 and November 2018. A total of 830 patients (512 males [61.8%] and 318 females [38.2%]) were included in the study. Gastropexy was performed for 428 (51.6%) patients (343 pigtail and 85 balloon-type gastrostomies). The remaining 402 patients (48.4%) had no gastropexy (387 pigtail and 15 balloon-type gastrostomies). Major and minor complication rates were assessed within 30 days postprocedure. Results: Technical success was 100% with and without gastropexy. Complications were recorded in 143 patients (17.2%): six major complications in 6 patients and 155 minor complications in 137 patients. Major complications included peritonitis (n = 1) and severe skin infection (n = 1) in the gastropexy group, whereas the remaining four complications were without gastropexy and had tube malposition and peritonitis (n = 4). There was no significant difference in major (0.47% vs. 1%; P = 0.37) or minor complication rate (18.7% vs. 14.2%; P = 0.08) between the gastropexy and nongastropexy groups, respectively. Subgroup analysis showed significantly more superficial infections in the gastropexy group (28 vs. 14; P = 0.04), and pneumoperitoneum was significantly more common with pigtail gastrostomy compared to the balloon-type catheter (30 vs. 0; P = 0.04). There was no significant difference in complication rates in relation to the number of anchors (P = 0.32 for major complications and P = 0.57 for minor complications). Thirty patients (3.6%) died within 30 days after the procedure due to other comorbidities. Conclusion: Gastropexy does not reduce the incidence of major or minor complications following percutaneous gastrostomy and is associated with increased risk for superficial infections. The use of pigtail-type gastrostomy is associated with a higher incidence of pneumoperitoneum.

Total glossectomy in multimodal treatment of oropharyngeal cancer: immediate results

The study objective is to analyze the results of combined antitumor therapy, which included glossectomy, to treat locally advanced and recurrent oropharyngeal squamous cell cancer.Materials and methods. We performed a retrospective analysis of multimodal antitumor therapy of 19 patients, who were treated in the Nizhny Novgorod Regional Clinical Oncologic Dispensary within 2009–2019. All patients underwent segmental resection of the mandible due to massive tumor invasion into the periosteum. After total glossectomy the defect was filled using pectoralis musculocutaneous flap. Due to the wide local tumor spread, a neck dissection (n = 7) or radical cervical lymphadenectomy (n = 12) were performed. During preventive surgery, metastases that were not detected before surgery were revealed in 2 patients in 1 neck lymph node. Results. Eleven patients had local purulent-necrotic postoperative complications. It was noted that after surgery but without radiation therapy complications developed in fewer patients (n = 4) and were less severe: of I degree – in 3 patients, of III degree – in 1 patient. Radiation therapy before surgery resulted in more severe purulent-necrotic complications in 7 patients: of I degree – in 2 patients, of II degree – in 1, of III degree – in 4. Mortality rates: 30-day, 60-day and 90-day – 10.5 %, 21 % and 37 %, respectively. The causes of death were complications of gastrostomy: profuse bleeding from the stomach wall (n = 1), acute psychosis complicated by cerebral edema (n = 1), increased heart failure (n = 1), necrosis of the anterior abdominal wall and cachexia, developed after gastrostomy (n = 1), continued tumor growth between chemotherapy courses (n = 3). Twelve patients survived more than 90 days after surgery, 3 patients – more than 2 years. As most of the patients could not swallow, they were administered a nasogastric tube, since a simultaneous gastrostomy increases the duration of a traumatic operation and aggravates the postoperative period.Conclusion. Multicomponent surgery after radiation therapy results in more often local purulent-necrotic postoperative complications than if the surgery is performed before radiation therapy. High mortality in the first 90 days after surgery (n = 7) due to local cancer spread is generally determined by the severe condition of patients with advanced cancer and the concomitant diseases. However, rejection of gastrostomy in favor of nasogastric tube seems reasonable, since several deaths in the early postoperative period may be occurred due to complications associated with gastrostomy.

Failure to thrive: The socioeconomics of pediatric gastrostomy complications

PurposeOne of the most common procedures in the pediatric population is the placement of a gastrostomy tube. There are significant medical, emotional, and social implications for both patients and caregivers. We hypothesized that socioeconomic status had a significant impact on gastrostomy complications. MethodsA retrospective chart review was performed. Patient and census data including median household income, unemployment rate, health insurance status, poverty level, and caregiver education level were merged. Statistical tests were conducted against a 2-sided alternative hypothesis with a 0.05 significance level. Outcomes examined were minor and major complications in association with socioeconomic variables. ResultsPatients with mechanical complications were younger, weighed less, and had a 72% greater chance of having commercial insurance. Patients with Medicare/self-pay were three times more likely to have a minor complication. The average unemployment rate was 23% greater in families with a major complication. Individuals with a minor complication came from community tracts with a lower percentage of families below the poverty level. ConclusionAn association between socioeconomic factors and gastrostomy complications was identified. Insurance status and employment status were more significant predictors than poverty level. Further work with variables for targeted interventions to provide specific family support will allow these children and families to thrive. Level of evidenceLevel II prognosis study.

General principles for the prevention and treatment of complications of percutaneous endoscopic gastrostomy (review of literature)

We considered the views of researchers presented in the modern literature on both the problem as a whole and discussion questions regarding the causes of development, preventive measures, and methods of treating percutaneous endoscopic gastrostomy complications, such as clogging of the gastrostomy tube, peristomal wound infections, necrotic fasciitis, pneumoperitoneum, buried bumper syndrome, growth of granulations in the gastrostomy zone, postoperative bleeding and intraparietal hematoma of the gastric wall, traumatic dislocation of the gastrostomy tube, peritonitis after percutaneous endoscopic gastrostomy, peristomal leakage, сolonic fistula, liver injury and abdominal wall metastasis at the percutaneous endoscopic gastrostomy site.

Percutaneous Endoscopic Gastrostomy After Cardiothoracic Surgery in Children Less Than 2 Months Old: An Assessment of Long-Term Malnutrition Status and Gastrostomy Outcomes.

Infants with critical congenital heart disease undergoing cardiothoracic surgery commonly experience chronic malnutrition and growth failure. We sought to determine whether placement of a percutaneous endoscopic gastrostomy was associated with reduced moderate-severe malnutrition status and to describe percutaneous endoscopic gastrostomy-related clinical and safety outcomes in this population. Single-center, retrospective cohort study. Two hundred fifty-nine-bed, tertiary care, pediatric referral center. Children with congenital heart disease less than 2 months old undergoing cardiothoracic surgery from 2007 to 2013 with and without percutaneous endoscopic gastrostomy. None. Primary outcomes were weight for age z scores during hospitalization, at 6 months, and 1 year after cardiothoracic surgery. Secondary outcomes were frequency of percutaneous endoscopic gastrostomy revision, percutaneous endoscopic gastrostomy complications, and mortality. Statistical analyses included Wilcoxon rank-sum, Fisher exact, and Student t tests. Two hundred twenty-two subjects met study criteria, and 77 (35%) had percutaneous endoscopic gastrostomy placed at a mean of 45 ± 31 days after cardiothoracic surgery. No differences were noted for demographics, comorbidities, and weight for age z score at birth and at the time of cardiothoracic surgery. The percutaneous endoscopic gastrostomy cohort had greater Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery risk category (4 [4-5] vs 4 [2-4]) and length of stay (71 d [49-101 d] vs 26 d [15-42 d]). Mean weight for age z score at the time of percutaneous endoscopic gastrostomy was -2.8 ± 1.3. Frequency of moderate-severe malnutrition (weight for age z score, ≤ -2) was greater in children with percutaneous endoscopic gastrostomy at discharge (78% vs 48%), 6 months (61% vs 16%), and 1 year (41% vs 2%). Index mortality was lower in children with percutaneous endoscopic gastrostomy at 30 days (8% vs 0%) and hospital discharge (19% vs 4%). However, no mortality differences were observed after discharge. Growth velocity after percutaneous endoscopic gastrostomy was greater (44 ± 19 vs 10 ± 9 g/d). Children tolerated percutaneous endoscopic gastrostomy without hemodynamic compromise, minor percutaneous endoscopic gastrostomy complications, and anticipated percutaneous endoscopic gastrostomy revisions. Children without mortality had percutaneous endoscopic gastrostomy removal at a median duration of 253 days (133-545 d). Children with univentricular physiology had improved in-hospital mean growth velocity (6.3 vs 24.4 g/d; p < 0.01) and reduced 1-year rate moderate-severe malnutrition (66.7% vs 36.9%; p < 0.01) after percutaneous endoscopic gastrostomy placement. Percutaneous endoscopic gastrostomy placement was well tolerated and associated with improved postoperative growth velocity in children with critical congenital heart disease undergoing cardiothoracic surgery less than 2 months old. These findings were also noted in our subanalysis of children with univentricular physiology. Persistent rates of moderate-severe malnutrition were noted at 1-year follow-up. Although potential index mortality benefit was observed, definitive data are still needed.