SAFETY AND EFFICACY OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN CHILDREN

Objectives: To establish the safety and efficacy of percutaneous endos copic gastrostomy (PEG) placement for nutritional support in children. Methods: The charts of 70 children who underwent the procedure betwee n 1989 and 1992 were reviewed. Three of the 70 had repeat PEG placemen t. Patients ranged in age from 3 months to 24 yr, and included 28 fema les and 42 males. In all patients, the weights at the time of insertio n of the PEG, and in 64, weight after 6 months of nutritional support, were compared by Z-score, and the incidence of major and minor compli cations was determined. Results: Forty-five of 70 patients (70%) had i mproved nutritional status after initiation of PEG feedings, and in th ree (4%), the weight was maintained despite limited oral intake. Patie nts with congenital heart disease (86%) and cystic fibrosis (80%) deri ved the greatest benefit from the enteral feedings. Major complication s were noted in 13 (19%) patients and minor complications in 16 (22%). Nine of 13 (70%) major complications and four of 116 (25%) minor comp lications occurred in the 12 (17%) children with multi-system organ fa ilure. The rate of major complication was significantly greater in chi ldren with multi-system organ failure than in all patients (p < 0.001) and their relative risk of complication was increased by a factor of 40. Conclusions: Our data indicate that PEG is a safe and effective mo dality for nutritional support in children without multi-system organ failure. Those with multi-system organ failure have an increased rate of complications and a poor response to nutritional support, suggestin g that the risk of PEG may outweigh its benefit for this population.