Abstract
Percutaneous endoscopic gastrostomy (PEG) is a relatively safe and minimally invasive surgical method for providing enteral access in children. In pediatrics, the indications for PEG placement frequently include malnutrition or failure to thrive, as well as oropharyngeal dysphagia, especially in children with neurological impairment (NI). The risk for postoperative complications is low. However, among children with NI, gastroesophageal reflux disease (GERD) may necessitate fundoplication prior to gastrostomy tube placement. Preoperative pH probe testing has not been shown to be an effective screening tool prior to PEG placement among patients with GERD. Laparoscopic gastrostomy tube insertion was introduced in pediatric patients in an attempt to decrease complications associated with PEG. Although outcomes were reported to be similar to or better than PEG alone, future comparative studies are needed to better define the optimal patient demographic for this technique.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Ciocon JO, Silverstone FA, Graver LM, Foley CJ. Tube feedings in elderly patients. Indications, benefits, and complications. Arch Intern Med. 1988;148(2):429–33.
Gauderer MW. Percutaneous endoscopic gastrostomy: a 10-year experience with 220 children. J Pediatr Surg. 1991;26(3):288–92. discussion 292–284.
Fox VL, Abel SD, Malas S, et al. Complications following percutaneous endoscopic gastrostomy and subsequent catheter replacement in children and young adults. Gastrointest Endosc. 1997;45(1):64–71.
Behrens R, Lang T, Muschweck H, et al. Percutaneous endoscopic gastrostomy in children and adolescents. J Pediatr Gastroenterol Nutr. 1997;25(5):487–91.
Amann W, Mischinger HJ, Berger A, et al. Percutaneous endoscopic gastrostomy (PEG). 8 years of clinical experience in 232 patients. Surg Endosc. 1997;11(7):741–4.
Gauderer MW, Ponsky JL, Izant Jr RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980;15(6):872–5.
Gauderer MW. Percutaneous endoscopic gastrostomy and the evolution of contemporary long-term enteral access. Clin Nutr. 2002;21(2):103–10.
• Fortunato JE, Troy AL, Cuffari C, et al.: Outcome after percutaneous endoscopic gastrostomy in children and young adults. J Pediatr Gastroenterol Nutr. Apr 2010;50(4):390–393. This paper examining the outcomes after PEG in children at the Johns Hopkins Children’s Center is the largest study to date, consisting of 760 patients over an 11-year period. The report demonstrated that preoperative diagnosis, indication, prematurity, and history of neurological impairment did not influence postoperative complications. It did suggest that younger patients and those with a preoperative history of dysphagia or aspiration on modified barium swallow study had a higher incidence of subsequent fundoplication.
Sulaeman E, Udall Jr JN, Brown RF, et al. Gastroesophageal reflux and Nissen fundoplication following percutaneous endoscopic gastrostomy in children. J Pediatr Gastroenterol Nutr. 1998;26(3):269–73.
Avitsland TL, Kristensen C, Emblem R, et al. Percutaneous endoscopic gastrostomy in children: a safe technique with major symptom relief and high parental satisfaction. J Pediatr Gastroenterol Nutr. 2006;43(5):624–8.
Grant JP. Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy. Ann Surg. 1988;207(5):598–603.
Ljungdahl M, Sundbom M. Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial. Surg Endosc. 2006;20(8):1248–51.
Stiegmann GV, Goff JS, Silas D, et al. Endoscopic versus operative gastrostomy: final results of a prospective randomized trial. Gastrointest Endosc. 1990;36(1):1–5.
Bankhead RR, Fisher CA, Rolandelli RH. Gastrostomy tube placement outcomes: comparison of surgical, endoscopic, and laparoscopic methods. Nutr Clin Pract. 2005;20(6):607–12.
Cosentini EP, Sautner T, Gnant M, et al. Outcomes of surgical, percutaneous endoscopic, and percutaneous radiologic gastrostomies. Arch Surg. 1998;133(10):1076–83.
Goretsky MF, Johnson N, Farrell M, Ziegler MM. Alternative techniques of feeding gastrostomy in children: a critical analysis. J Am Coll Surg. 1996;182(3):233–40.
Preshaw RM. A percutaneous method for inserting a feeding gastrostomy tube. Surg Gynecol Obstet. 1981;152(5):658–60.
• Nah SA, Narayanaswamy B, Eaton S, et al.: Gastrostomy insertion in children: percutaneous endoscopic or percutaneous image-guided? J Pediatr Surg. Jun 2010;45(6):1153–1158. This paper compared gastrostomy insertion via PEG placed by surgeons versus interventional radiologists. The authors demonstrated that although major complications were rare, they were more frequent in those tubes placed by radiologists.
Nagle AP, Murayama KM. Laparoscopic gastrostomy and jejunostomy. J Long Term Eff Med Implants. 2004;14(1):1–11.
Ho HS, Ngo H. Gastrostomy for enteral access. A comparison among placement by laparotomy, laparoscopy, and endoscopy. Surg Endosc. 1999;13(10):991–4.
Rothenberg SS, Bealer JF, Chang JH. Primary laparoscopic placement of gastrostomy buttons for feeding tubes. A safer and simpler technique Surg Endosc. 1999;13(10):995–7.
Zamakhshary M, Jamal M, Blair GK, et al. Laparoscopic vs percutaneous endoscopic gastrostomy tube insertion: a new pediatric gold standard? J Pediatr Surg. 2005;40(5):859–62.
• Akay B, Capizzani TR, Lee AM, et al.: Gastrostomy tube placement in infants and children: is there a preferred technique? J Pediatr Surg. Jun 2010;45(6):1147–1152. This report compares placement of gastrostomy tubes in infants and children using PEG alone and laparoscopic-assisted PEG. Although operative time for PEG alone was shorter than laparoscopically assisted gastrostomy placement, there were more complications requiring a second operation in the PEG-alone group.
Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. J Gastroenterol Hepatol. 2000;15(1):21–5.
Miller RE, Castlemain B, Lacqua FJ, Kotler DP. Percutaneous endoscopic gastrostomy. Results in 316 patients and review of literature. Surg Endosc. 1989;3(4):186–90.
Heine RG, Reddihough DS, Catto-Smith AG. Gastro-oesophageal reflux and feeding problems after gastrostomy in children with severe neurological impairment. Dev Med Child Neurol. 1995;37(4):320–9.
Mathus-Vliegen EM, Koning H, Taminiau JA, Moorman-Voestermans CG. Percutaneous endoscopic gastrostomy and gastrojejunostomy in psychomotor retarded subjects: a follow-up covering 106 patient years. J Pediatr Gastroenterol Nutr. 2001;33(4):488–94.
Brant CQ, Stanich P, Ferrari Jr AP. Improvement of children’s nutritional status after enteral feeding by PEG: an interim report. Gastrointest Endosc. 1999;50(2):183–8.
Borowitz SM, Sutphen JL, Hutcheson RL. Percutaneous endoscopic gastrostomy without an antireflux procedure in neurologically disabled children. Clin Pediatr (Phila). 1997;36(1):25–9.
Cameron BH, Blair GK, Murphy 3rd JJ. Fraser GC: Morbidity in neurologically impaired children after percutaneous endoscopic versus Stamm gastrostomy. Gastrointest Endosc. 1995;42(1):41–4.
Sullivan PB, Juszczak E, Bachlet AM, et al. Gastrostomy tube feeding in children with cerebral palsy: a prospective, longitudinal study. Dev Med Child Neurol. 2005;47(2):77–85.
Sullivan PB, Juszczak E, Bachlet AM, et al. Impact of gastrostomy tube feeding on the quality of life of carers of children with cerebral palsy. Dev Med Child Neurol. 2004;46(12):796–800.
Sullivan PB, Alder N, Bachlet AM, et al. Gastrostomy feeding in cerebral palsy: too much of a good thing? Dev Med Child Neurol. 2006;48(11):877–82.
Grunow JE, al-Hafidh A, Tunell WP. Gastroesophageal reflux following percutaneous endoscopic gastrostomy in children. J Pediatr Surg. 1989;24(1):42–4. Discussion 44–45.
Razeghi S, Lang T, Behrens R. Influence of percutaneous endoscopic gastrostomy on gastroesophageal reflux: a prospective study in 68 children. J Pediatr Gastroenterol Nutr. 2002;35(1):27–30.
Launay V, Gottrand F, Turck D, et al. Percutaneous endoscopic gastrostomy in children: influence on gastroesophageal reflux. Pediatrics. 1996;97(5):726–8.
Wilson GJ, van der Zee DC, Bax NM. Endoscopic gastrostomy placement in the child with gastroesophageal reflux: is concomitant antireflux surgery indicated? J Pediatr Surg. 2006;41(8):1441–5.
Samuel M, Holmes K. Quantitative and qualitative analysis of gastroesophageal reflux after percutaneous endoscopic gastrostomy. J Pediatr Surg. 2002;37(2):256–61.
Sondheimer JM, Morris BA. Gastroesophageal reflux among severely retarded children. J Pediatr. 1979;94(5):710–4.
Novotny NM, Jester AL, Ladd AP. Preoperative prediction of need for fundoplication before gastrostomy tube placement in children. J Pediatr Surg. 2009;44(1):173–6. discussion 176–177.
Puntis JW, Thwaites R, Abel G, Stringer MD. Children with neurological disorders do not always need fundoplication concomitant with percutaneous endoscopic gastrostomy. Dev Med Child Neurol. 2000;42(2):97–9.
Hament JM, Bax NM, van der Zee DC, et al. Complications of percutaneous endoscopic gastrostomy with or without concomitant antireflux surgery in 96 children. J Pediatr Surg. 2001;36(9):1412–5.
Ni YH, Chang MH, Hsu HY, et al. Percutaneous endoscopic gastrostomy in infants. J Formos Med Assoc. 1995;94(10):635–7.
Wilson L, Oliva-Hemker M. Percutaneous endoscopic gastrostomy in small medically complex infants. Endoscopy. 2001;33(5):433–6.
Loser C, Aschl G, Hebuterne X, et al. ESPEN guidelines on artificial enteral nutrition–percutaneous endoscopic gastrostomy (PEG). Clin Nutr. 2005;24(5):848–61.
Backman T, Arnbjornsson E, Berglund Y, Larsson LT. Video-assisted gastrostomy in infants less than 1 year. Pediatr Surg Int. 2006;22(3):243–6.
Erdil A, Saka M, Ates Y, et al. Enteral nutrition via percutaneous endoscopic gastrostomy and nutritional status of patients: five-year prospective study. J Gastroenterol Hepatol. 2005;20(7):1002–7.
Loser C, Wolters S, Folsch UR. Enteral long-term nutrition via percutaneous endoscopic gastrostomy (PEG) in 210 patients: a four-year prospective study. Dig Dis Sci. 1998;43(11):2549–57.
Jafri NS, Mahid SS, Minor KS, et al. Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy. Aliment Pharmacol Ther. 2007;25(6):647–56.
Rey JR, Axon A, Budzynska A, et al. Guidelines of the European Society of Gastrointestinal Endoscopy (E.S.G.E.) antibiotic prophylaxis for gastrointestinal endoscopy. European Society of Gastrointestinal Endoscopy. Endoscopy. 1998;30(3):318–24.
Snyder J, Bratton B. Antimicrobial prophylaxis for gastrointestinal procedures: current practices in North American academic pediatric programs. J Pediatr Gastroenterol Nutr. 2002;35(4):564–9.
Rawat D, Srivistava A, Thomson M. Antibody prophylaxis for children undergoing percutaneous endoscopic gastrostomy. J Pediatr Gastroenterol Nutr. 2005;40(2):234–5.
Marin OE, Glassman MS, Schoen BT, Caplan DB. Safety and efficacy of percutaneous endoscopic gastrostomy in children. Am J Gastroenterol. 1994;89(3):357–61.
Khattak IU, Kimber C, Kiely EM, Spitz L. Percutaneous endoscopic gastrostomy in paediatric practice: complications and outcome. J Pediatr Surg. 1998;33(1):67–72.
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Conflicts of interest: J.E. Fortunato—none; C. Cuffari—none.
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Fortunato, J.E., Cuffari, C. Outcomes of Percutaneous Endoscopic Gastrostomy in Children. Curr Gastroenterol Rep 13, 293–299 (2011). https://doi.org/10.1007/s11894-011-0189-5
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DOI: https://doi.org/10.1007/s11894-011-0189-5