Issn Print: 0277-2116
Publication Date: 1997/10/01
COMPLICATIONS OF PERCUTANEOUS ENDOSCOPICALLY PLACED GASTROSTOMY TUBES IN PEDIATRIC PATIENTS VARY WITH DIAGNOSIS: 90
H R Thompson; J M Sondheimer
Excerpt
We reviewed all percutaneous endoscopic gastrostomies (PEG) placed by Gl fellows and attendings at The Children's Hospital, Denver from 6/92-9/96. We wished to evaluate complications overall and in specific high risk patient subsets. Major complications were gastro-esophageal reflux (GER) requiring surgical therapy, inability to place PEG, bowel perforation and hospital readmission within 24 hours of discharge. Minor complications were mechanical problems (broken or dislodged PEG), cellulitis requiring antibiotics, bleeding, symptomatic GER and feeding intolerance. Immediate complications occurred in the first 30 days and delayed after 30 days. Of 70 PEGs, 10 patients had major complications (14%) - GER requiring fundoplication (5), bowel perforation (2), failure to place PEG (2) and readmission secondary to feeding intolerance (1). Three major complications were immediate and seven delayed. There were 25 minor complications, 8 immediate - nausea (5), cellulitis (3), and 17 delayed - tube malfunction (9), PEG site bleeding (5), cellulitis (2) and medically responsive GER (1). 9 PEGs (13%) were placed in patients with HIV, mean age 133.6±75.8 months, mean weight 23±12.2kg. Mean weight gain was 2.0±0.69kg one month after PEG. The only complication in this group was readmission for feeding intolerance. 9 PEGs (13%) were placed in patients with CF, mean age 133.6±74.7 months, mean weight 26.1±10.6kg. Mean weight gain was 1.06±0.24kg one month after PEG. The only complication in this group was medically responsive GER. 39 PEGs (55%) were placed in patients with neurologic disease, mean age 70.2±66.9 months, mean weight 15±12.6kg. Mean weight gain was 0.69±0.11kg one month after PEG. There were 8 major complications (80% of total), five fundoplications, two bowel perforations and one failure to place PEG. Pediatric patients with neurologic disease are at increased risk for complications after PEG compared with other high risk groups. These patients were significantly younger (p<0.02) than the CF and HIV groups and weighed less (p<0.02) than the patients with CF.
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