Clin Endosc.  2018 May;51(3):260-265. 10.5946/ce.2017.137.

Infant Percutaneous Endoscopic Gastrostomy: Risks or Benefits?

• Macchini F
• Zanini A
• Farris G
• Morandi A
• Brisighelli G
• Gentilino
• Fava G
• Leva E

• KMID: 2414867
• DOI: http://doi.org/10.5946/ce.2017.137

Abstract

BACKGROUND/AIMS
To present a single center's experience with percutaneous endoscopic gastrostomy (PEG) tube placement in infants.
METHODS
Clinical records of infants who underwent PEG tube placement between January 2010 and December 2015 were reviewed. All patients underwent an upper gastrointestinal contrast study and an abdominal ultrasonography before the procedure. PEGs were performed with a 6-mm endoscope using the standard pull-through technique. Data regarding gestational age, birth weight, age and weight, days to feeding start, days to full diet, and complications were reviewed.
RESULTS
Twenty-three patients were included. The most common indication was dysphagia related to hypoxic-ischemic encephalopathy. Median gestational age was 37 weeks (range, 24-41) and median birth weight was 2,605 grams (560-4,460). Patients underwent PEG procedures at a median age of 114 days (48-350); mean weight was 5.1 kg (3.2-8.8). In all patients but one, a 12-Fr tube was positioned. Median feeding start was 3 days (1-5) and on average full diet was achieved 5 days after the procedure (2-11). Six minor complications were recorded and effectively treated in the outpatient clinic; no major complications were recorded.
CONCLUSIONS
PEG is safe and feasible in infants when performed by highly experienced physicians.

Keyword

Percutaneous endoscopic gastrostomy; Infant; Nutrition

MeSH Terms

Ambulatory Care Facilities
Birth Weight
Deglutition Disorders
Diet
Endoscopes
Gastrostomy*
Gestational Age
Humans
Hypoxia-Ischemia, Brain
Infant*
Ultrasonography

Reference

1. Loser C, Aschl G, Hébuterne X, et al. ESPEN guidelines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG). Clin Nutr. 2005; 24:848–861.

2. Merli L, De Marco EA, Fedele C, et al. Gastrostomy placement in children: percutaneous endoscopic gastrostomy or laparoscopic gastrostomy? Surg Laparosc Endosc Percutan Tech. 2016; 26:381–384.

3. Wilson L, Oliva-Hemker M. Percutaneous endoscopic gastrostomy in small medically complex infants. Endoscopy. 2001; 33:433–436.

4. Sulkowski JP, De Roo AC, Nielsen J, et al. A comparison of pediatric gastrostomy tube placement techniques. Pediatr Surg Int. 2016; 32:269–275.

5. Gauderer MW, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg. 1980; 15:872–875.

6. Viktorsdottir MB, Óskarsson K, Gunnarsdóttir A, Sigurdsson L. Percutaneous endoscopic gastrostomy in children: a population-based study from iceland, 1999-2010. J Laparoendosc Adv Surg Tech A. 2015; 25:248–251.

7. Minar P, Garland J, Martinez A, Werlin S. Safety of percutaneous endoscopic gastrostomy in medically complicated infants. J Pediatr Gastroenterol Nutr. 2011; 53:293–295.

8. ASGE Standards of Practice Committee, Lightdale JR, Acosta R, et al. Modifications in endoscopic practice for pediatric patients. Gastrointest Endosc. 2014; 79:699–710.

9. Landisch RM, Colwell RC, Densmore JC. Infant gastrostomy outcomes: the cost of complications. J Pediatr Surg. 2016; 51:1976–1982.

10. Gauderer MWL, Stellato TA. Percutaneous endoscopic gastrostomy in children: the technique in detail. Pediatr Surg Int. 1991; 6:82–87.

11. McSweeney ME, Jiang H, Deutsch AJ, Atmadja M, Lightdale JR. Long-term outcomes of infants and children undergoing percutaneous endoscopy gastrostomy tube placement. J Pediatr Gastroenterol Nutr. 2013; 57:663–667.

12. McSweeney ME, Kerr J, Jiang H, Lightdale JR. Risk factors for complications in infants and children with percutaneous endoscopic gastrostomy tubes. J Pediatr. 2015; 166:1514–1519. e1.

13. Sathiyamurthy S, Banerjee J, Godambe SV. Antiseptic use in the neonatal intensive care unit - a dilemma in clinical practice: an evidence based review. World J Clin Pediatr. 2016; 5:159–171.

14. Jafri NS, Mahid SS, Minor KS, Idstein SR, Hornung CA, Galandiuk S. Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy. Aliment Pharmacol Ther. 2007; 25:647–656.

15. Seekri IK, Rescorla FJ, Canal DF, Zollinger TW, Saywell R Jr, Grosfeld JL. Lesser curvature gastrostomy reduces the incidence of postoperative gastroesophageal reflux. J Pediatr Surg. 1991; 26:982–984. discussion 984-985.

16. Fox VL, Abel SD, Malas S, Duggan C, Leichtner AM. Complications following percutaneous endoscopic gastrostomy and subsequent catheter replacement in children and young adults. Gastrointest Endosc. 1997; 45:64–71.

17. Sporik R. Why block a small hole? The adverse effects of nasogastric tubes. Arch Dis Child. 1994; 71:393–394.

18. Greenspan JS, Wolfson MR, Holt WJ, Shaffer TH. Neonatal gastric intubation: differential respiratory effects between nasogastric and orogastric tubes. Pediatr Pulmonol. 1990; 8:254–258.

19. Raddish M, Merritt TA. Early discharge of premature infants. A critical analysis. Clin Perinatol. 1998; 25:499–520.

20. Baker L, Beres AL, Baird R. A systematic review and meta-analysis of gastrostomy insertion techniques in children. J Pediatr Surg. 2015; 50:718–725.

21. Ljungdahl M, Sundbom M. Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial. Surg Endosc. 2006; 20:1248–1251.

22. Jones VS, La Hei ER, Shun A. Laparoscopic gastrostomy: the preferred method of gastrostomy in children. Pediatr Surg Int. 2007; 23:1085–1089.

23. Behrens R, Lang T, Muschweck H, Richter T, Hofbeck M. Percutaneous endoscopic gastrostomy in children and adolescents. J Pediatr Gastroenterol Nutr. 1997; 25:487–491.

24. Khattak IU, Kimber C, Kiely EM, Spitz L. Percutaneous endoscopic gastrostomy in paediatric practice: complications and outcome. J Pediatr Surg. 1998; 33:67–72.

25. Kutiyanawala MA, Hussain A, Johnstone JM, Everson NW, Nour S. Gastrostomy complications in infants and children. Ann R Coll Surg Engl. 1998; 80:240–243.

26. Davidson PM, Catto-Smith AG, Beasley SW. Technique and complications of percutaneous endoscopic gastrostomy in children. Aust N Z J Surg. 1995; 65:194–196.

27. Vervloessem D, van Leersum F, Boer D, et al. Percutaneous endoscopic gastrostomy (PEG) in children is not a minor procedure: risk factors for major complications. Semin Pediatr Surg. 2009; 18:93–97.

28. Oterdoom LH, Marinus Oterdoom DL, Ket JCF, van Dijk JMC, Scholten P. Systematic review of ventricular peritoneal shunt and percutaneous endoscopic gastrostomy: a safe combination. J Neurosurg. 2017; 127:899–904.

29. McSweeney ME, Smithers CJ. Advances in pediatric gastrostomy placement. Gastrointest Endosc Clin N Am. 2016; 26:169–185.

30. Hassall E. Requirements for training to ensure competence of endoscopists performing invasive procedures in children. Training and education committee of the North American society for pediatric gastroenterology and nutrition (NASPGN), the ad hoc pediatric committee of American society for gastrointestinal endoscopy (ASGE), and the executive council of NASPGN. J Pediatr Gastroenterol Nutr. 1997; 24:345–347.

31. Fascetti-Leon F, Gamba P, Dall’Oglio L, et al. Complications of percutaneous endoscopic gastrostomy in children: results of an Italian multicenter observational study. Dig Liver Dis. 2012; 44:655–659.