Complications of percutaneous endoscopic gastrostomy with or without concomitant antireflux surgery in 96 children

Background/Purpose: A study was conducted of the complications of percutane ous endoscopic gastrostomy (PEG) with or without antireflux surgery (ARS). Methods: A retrospective review was conducted of all patients, receiving a PEG in the period January 1993 through December 1997. Patients' characteris tics including underlying disease, indications, results of preoperative scr eening, and complications were recorded. PEG placement was performed with t he Seldinger technique and, in some cases, under laparoscopic control. In t he event of a pathologic pH study during preoperative screening, laparoscop ic antireflux surgery (ARS) was added. Results: Mean age was 5 years and 10 months. The majority of the children w ere mentally retarded. The main indications for PEG were vomiting, food ref usal, inability to swallow, and aspiration. Fifty-nine patients had PEG wit hout ARS. Nineteen of these patients had concomitant laparoscopy. Thirty-se ven patients had PEG with ARS. One patient died postoperatively of gastric leakage. PEG-related complications occurred in 31% of the patients. There w as a significant higher incidence of complications in the group of patients that underwent ARS together with PEG compared with PEG placement without A RS. Roughly half of the complications were peristomal infection related to the use of T-fasteners and the other half gastroduodenal obstruction caused by the balloon of the gastrostomy catheter, both preventable complications . Preoperative vomiting without a positive pH-study disappeared in most cas es after PEG placement. Although the pH study normalized in 34 of 37 patien ts after concomitant ARS, vomiting persisted in 7 of 17 patients. PEG impro ved the nutritional status in 75% of the children. Conclusions: PEG improved the nutritional status in the majority of the chi ldren. However, PEG placement can lead to a considerable amount of complica tions, especially when combined with ARS. ARS together with PEG is successf ul in treating GER but does not necessarily cure preexistent vomiting. PEG alone cures vomiting in 80% of the patients and rarely leads to vomiting. T here seems no good reason for combining PEG with ARS, Only if symptoms prog ress after PEG, ARS should be considered. Caretakers and patients should be well informed before placement. J Pediatr Surg 36:1412-1415, Copyright (C) 2001 by W.B. Saunders Company.