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Safety and efficacy of percutaneous endoscopic gastrostomy in children.

OBJECTIVES
To establish the safety and efficacy of percutaneous endoscopic gastrostomy (PEG) placement for nutritional support in children.


METHODS
The charts of 70 children who underwent the procedure between 1989 and 1992 were reviewed. Three of the 70 had repeat PEG placement. Patients ranged in age from 3 months to 24 yr, and included 28 females and 42 males. In all patients, the weights at the time of insertion of the PEG, and in 64, weight after 6 months of nutritional support, were compared by Z-score, and the incidence of major and minor complications was determined.


RESULTS
Forty-five of 70 patients (70%) had improved nutritional status after initiation of PEG feedings, and in three (4%), the weight was maintained despite limited oral intake. Patients with congenital heart disease (86%) and cystic fibrosis (80%) derived the greatest benefit from the enteral feedings. Major complications were noted in 13 (19%) patients and minor complications in 16 (22%). Nine of 13 (70%) major complications and four of 116 (25%) minor complications occurred in the 12 (17%) children with multi-system organ failure. The rate of major complication was significantly greater in children with multi-system organ failure than in all patients (p < 0.001) and their relative risk of complication was increased by a factor of 40.


CONCLUSIONS
Our data indicate that PEG is a safe and effective modality for nutritional support in children without multi-system organ failure. Those with multi-system organ failure have an increased rate of complications and a poor response to nutritional support, suggesting that the risk of PEG may outweigh its benefit for this population.