Percutaneous Endoscopic Gastrostomy in Small Medically Complex Infants

Background and Study Aims: Percutaneous endoscopic gastrostomy (PEG) is an established procedure for pediatric patients; however, there is still relatively little information on its feasibility and safety in very small infants. The aim of this study was to investigate the safety of percutaneous endoscopic gastrostomy in infants weighing less than 3.5 kg.

Patients and Methods: The charts of 26 infants weighing less than 3.5 kg who received PEGs were retrospectively reviewed.

Results: At the time of gastrostomy insertion the mean weight was 3 kg and the mean age was 2.3 months. This population of infants carried multiple diagnoses including lung disease of prematurity, swallowing dysfunction, chromosomal abnormality, structural facial anomaly, neurological deficit and congenital heart disease. Infants received either a 14- or 15-Fr percutaneous endoscopic gastrostomy tube under general anesthesia. All 26 procedures were successfully completed. Two infants (7.6 %) developed a pneumoperitoneum during the procedure which required intervention. Two infants (7.6 %) were conservatively treated with oral antibiotics for mild skin erythema and one infant (3.8 %) required intravenous antibiotics for cellulitis of the stoma site. There were no other complications. To date, 16 of the gastrostomy tubes (61.5 %) have been removed by traction without complication.

Conclusions: PEGs can be safely placed in very small, medically complex infants. Pneumoperitoneum, which is a common but usually insignificant occurrence in adults and children during PEG placement, may require intervention in the small infant.

References

• 1 Gauderer M WL, Ponsky J L, Izant R J Jr. Gastrostomy without laparotomy: a percutaneous endoscopic technique.  J Pediatr Surg. 1980;  15 872-875
• 2 Larson D E, Burton D D, Schroeder K W, Dimagno E P. Percutaneous endoscopic gastrostomy: indications, success, complications, and mortality in 314 consecutive patients.  Gastroenterology. 1987;  93 48-52
• 3 Mamel J. Percutaneous endoscopic gastrostomy.  Am J Gastroenterol. 1989;  84 703-710
• 4 Gauderer M WL. Percutaneous endoscopic gastrostomy: a 10-year experience with 220 children.  J Pediatr Surg. 1991;  26 288-294
• 5 Marin O E, Glassman M S, Schoen B T, Caplan D B. Safety and efficacy of percutaneous endoscopic gastrostomy in children.  Am J Gastroenterol. 1994;  89 357-361
• 6 Grant J P. Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy.  Ann Surg. 1988;  207 598-603
• 7 Coughlin J P, Gauderer M WL, Stellato T A. Percutaneous endoscopic gastrostomy in children under 1 year of age: indications, complications, and outcome.  Pediatr Surg Int. 1991;  6 88-91
• 8 Ni Y H, Chang M H, Hsu H Y, et al. Percutaneous endoscopic gastrostomy in infants.  J Formos Med Assoc. 1995;  94 635-637
• 9 Raddish M, Merritt T A. Early discharge of premature infants. A critical analysis.  Clin Perinatol. 1998;  25 499-521
• 10 Hamill P VV, Drizd T A, Johnson C L, et al. Physical growth: national center for health statistics percentiles.  Am J Clin Nutr. 1979;  32 607-629
• 11 Sporik R. Why block a small hole? The adverse effects of nasogastric tubes.  Arch Dis Child. 1994;  71 393-394
• 12 Greenspan J S, Wolfson M R, Holt W J, Shaffer T H. Neonatal gastric intubation: differential respiratory effects between nasogastric and orogastric tubes.  Pediatr Pulmonol. 1991;  11 1-7
• 13 Mattis L E, Saavedra J M. Factors associated with risk of aspiration in pediatric tube-fed patients in a tertiary care hospital (abstract).  J Pediatr Gastroenterol Nutr. 1995;  21 357
• 14 Borowitz S M, Sutphen J L, Hutcheson R L. Percutaneous endoscopic gastrostomy without an antireflux procedure in neurologically disabled children.  Clin Pediatr (Phila). 1997;  36 25-29
• 15 Steinkamp G, von der Hardt H. Improvement of nutritional status and lung function after long-term nocturnal gastrostomy feedings in cystic fibrosis.  J Pediatr. 1994;  124 244-249
• 16 Aquino V M, Smyrl C B, Hagg R, et al. Enteral nutritional support by gastrostomy tube in children with cancer.  J Pediatr. 1995;  127 58-62
• 17 Behrens R, Lang T, Muschweek H, et al. Percutaneous endoscopic gastrostomy in children and adolescents.  J Pediatr Gastroenterol . Nutr 1997;  25 487-491
• 18 Khattak I U, Kimber C, Kiely E M, Spitz L. Percutaneous endoscopic gastrostomy in paediatric practice: complications and outcomes.  J Pediatr Surg. 1998;  33 67-72
• 19 Fox V, Abel S C, Malas S, et al. Complications following percutaneous endoscopic gastrostomy and subsequent catheter replacement in children and young adults.  Gastrointest Endosc. 1997;  45 64-71
• 20 Kutiyanawala M A, Hussain A, Johnstone J MS, et al. Gastrostomy complications in infants and children.  Ann R Coll Surg Engl. 1998;  80 240-243
• 21 Davidson P M, Catto-Smith A G, Beasley S W. Technique and complications of percutaneous endoscopic gastrostomy in children.  Aust N Z J Surg. 1995;  65 194-196
• 22 Pidala M J, Slezak F A, Porter J A. Pneumoperitoneum following percutaneous endoscopic gastrostomy. Does the timing of panendoscopy matter?.  Surg Endosc. 1992;  6 128-129
• 23 Gottfried E B, Plumser A B, Clair M R. Pneumoperitoneum following percutaneous endoscopic gastrostomy. A prospective study.  Gastrointest Endosc. 1986;  32 397-399
• 24 Benkov K J. When ‘buttoning up’ is not sound advice.  J Pediatr Gastroenterol Nutr. 1993;  17 358-360
• 25 Romero R, Martinez F L, Hart M H. Percutaneous endoscopic gastrostomy to skin-level gastrostomy conversions: analysis of risk factors (abstract).  J Pediatr Gastroenterol Nutr. 1995;  21 32