COMPLICATIONS OF RETAINED INTERNAL BOLSTER AFTER PEDIATRIC PERCUTANEOUS ENDOSCOPIC GASTROSTOMY

Purpose: Percutaneous endoscopic gastrostomy (PEG) has been widely acc epted as an efficacious means of nutritional support in the infant and child. A well-described technique uses the Gauderer-Ponsky tube (CR B ard Incorporated, Tewksbury, MA) drawn antegrade through the gastric w all and secured by an internal and external SILASTIC(R) (Dow Coming; M idland, MI) bolster. The majority of reported complications attendant to its use occur secondary to insertion. This report details a less we ll-described complication of tube removal. Methods: Since 1992, 234 pe diatric PEGs have been performed using a Gauderer-Ponsky tube. Approxi mately 6 weeks after the procedure, all catheters were removed and rep laced with gastric buttons. The internal bolster was left within the s tomach to pass spontaneously. Results: Five children (2.1%), ages 6 mo nths to 5 years, failed to pass this crossbar. Three subsequently pres ented with dysphagia and drooling with the internal bolster wedged in the proximal esophagus. All were left with significant residual strict ure after endoscopic removal of the crossbar. Two required dilatation and the third underwent operative stricturoplasty. A fourth child retu rned with intermittent gastric outlet obstruction. The internal bolste r was retained in the stomach 4 months after catheter removal. Endosco pic retrieval resulted in resolution of the symptomatology. The final case was found to have an asymptomatic bolster in the stomach approxim ately 18 months after catheter removal. Conclusions: These cases highl ight a potential sequelae of pediatric percutaneous endoscopic gastros tomy not previously acknowledged. The significant complications associ ated with the retained bolster in four of these five children suggests that follow-up should be altered to monitor prompt passage of the cro ssbar after tube removal. Copyright (C) 1998 by W.B. Saunders Company.