Percutaneous endoscopic gastrostomy in children under 1 year of age: indications, complications, and outcome

Abstract

During the 9-year period from June 1979 to July 1988, 197 percutaneous endoscopic gastrotomies (PEG) were performed by us in infants and children; 69 (35%) were placed in 68 infants 12 months of age or younger. Indications for the PEG in this latter group were: (1) inability to swallow: 48 (CNS lesions — 40; maxillofacial malformations — 4; oropharyngeal dysmotility — 2; vocal cord paralysis — 2); (2) long-term continuous enteral feedings: 20 (cardiopulmonary lesions and inadequate caloric intake — 14; short gut syndrome — 3; malabsorption and chronic diarrhea — 3); and (3) access for nonpalatable medication in 1 case. Forty-four infants weighed 5 kg or less; of these, 9 weighed less than 3 kg. Seventeen had had previous abdominal procedures. PEG was successfully performed in all 69 attempts. Major complications included: 1 death related to postoperative cardiac failure, 1 operative catheter change (retrsopectively unnecessary), and 1 gastrocolic fistula (operatively corrected). Follow-up was possible in 67 of the 68 infants and revealed the following: 18 patients died of their original disease with the PEG in place; the gastrostomy was no longer needed and was removed in 19, while 31 were using the gastrostomy at the time of completion of the study. Pre-PEG gastroesophageal reflux (GER) was diagnosed in 27 of 69 patients (39%); 14 of these have had no significant long-term problems with GER. Of the remaining 13, 11 required fundoplication while 2 with severe reflux were judged too ill to undergo an anti-reflux procedure. Of the 41 infants without pre-PEG GER, fundoplication was subsequently required in a cas 3${\raise0.5ex\hbox{$\scriptstyle 1$}\kern-0.1em/\kern-0.15em\lower0.25ex\hbox{$\scriptstyle 2$}}$ years after PEG removal. Since 4 patients were followed for less than 6 months and the 2 refluxing patients were also excluded, only 12 anti-reflux procedures were performed in 62 evaluable patients (19.3%). Fundoplications in this subset were associated with major complications. GER was not implicated in the deaths of any of the 18 patients who died with the PEG in place. PEG has proven to be simple, safe, and effective in this heterogeneous, high-risk group of children. These results encourage us to recommend PEG as a useful modality for infants requiring enteral access.