Percutaneous endoscopic gastrostomy and gastrojejunostomy in psychomotor retarded subjects: A follow-up covering 106 patient years

Background: Whether psychomotor retarded persons should be treated by percu taneous endoscopic gastrostomy (PEG) or by surgical gastrostomy combined wi th an antireflux procedure is controversial. Therefore the authors investig ated the feasibility of a PEG and enteral feeding in these patients. Methods: Patients referred from specialized institutions for a PEG placemen t were assessed extensively by a multidisciplinary team. When considered el igible, age and general condition determined the choice of treatment under general anesthesia (group 1) or conscious sedation (group 2). Patients were followed up after 1 and 7 days, 4 and 12 weeks, and thereafter every 6 to 12 weeks. Data were collected prospectively over a period of 5 years until gastrostomy removal, death, or arrival at the censory date, 6 months after PEG placement. The endpoints were 1) to evaluate the procedure and its comp lications; 2) to discover barriers that impeded adequate nutrition; and 3) to explore the appropriateness of the choice of PEG or percutaneous endosco pic gastrojejunostomy (PEJ). Results: The procedure was successful in 95% of patients, in every patient in group 1 (35/35; median age, 4.1 years) and in 20 of 23 patients (87%) in group 2 (median age, 22.0 years). There were no procedure-related deaths a nd no 30-day mortality. Major complications changed from procedure-related problems in the short term (5.4%) to tube-related problems in the long-term (24.1%). Nausea and vomiting interfered with adequate feeding mainly in yo ung children, but dietary adjustments alleviated the symptoms and ensured a n adequate intake. The choice of a PEG was incorrect in four patients: surg ery was needed twice and two PEGS had to be converted into a PEJ. All seven primarily indicated PEJs seemed justified and of temporary need in five. Conclusions: In severely disabled patients, a PEG and adequate enteral nutr ition is feasible in the setting of a multidisciplinary approach and protoc ol-wise follow-up. Yet, anatomic deformities and restricted pulmonary funct ion rendered the procedure more difficult. In cases with obvious aspiration or gastroesophageal reflux, a PEJ combined with acid suppression and proki netic drugs may be tried before surgery.