PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN PEDIATRIC PRACTICE - COMPLICATIONS AND OUTCOME

Purpose: The aim of this study was to establish the morbidity and mort ality of percutaneous endoscopic gastrostomy (PEG) in a tertiary refer ral paediatric practice and to identify risk factors for developing co mplications after a PEG.Methods: The medical records of all patients w ho had a percutaneous endoscopic gastrostomy attempted over a 5-year p eriod (1990 to 1995) were reviewed. Results: One hundred thirty percut aneous gastrostomies were placed in 120 paediatric patients. Indicatio ns for insertion were inability to swallow (n = 74, of which, 52 were neurologically impaired), inadequate calorie intake (n = 30), special feeding requirements (n = 12), continuous enteral feeding in short gut (n = 2), and malabsorption (n = 2). All the children had complex medi cal problems, and 80% of the patients were rated as ''high risk'' for general anaesthesia (greater than or equal to ASA grade 3). Major comp lications developed in 21 children (17.5%) and minor complications in 27 (22.5%). Of the 17 children in whom gastroesophageal reflux (GOR) b ecame symptomatic, 10 required a Nissen fundoplication. Nine of these 10 children were neurologically impaired (19% of the neurologically im paired children). One postrenal transplant patient on immunosuppressio n died 54 days after the procedure of intraabdominal sepsis. Thirty-on e patients required secondary surgical procedures. Conclusions: PEG is associated with significant morbidity. Neurologically impaired childr en are at risk of acquiring symptomatic GOR, but the risk does not war rant routine fundoplication. Major complications are common and need u rgent surgical consultation with many requiring secondary surgical pro cedures. PEG in paediatric patients should be considered a major surgi cal undertaking. Copyright (C) 1998 by W.B. Saunders Company.