Complications in children with percutaneous endoscopic gastrostomy (PEG) placement
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REVIEW ARTICLE
Complications in children with percutaneous endoscopic gastrostomy (PEG) placement Brigitta Balogh1 · Tamás Kovács1 · Amulya Kumar Saxena2 Received: 24 April 2018 / Accepted: 29 October 2018 © Children’s Hospital, Zhejiang University School of Medicine 2018
Abstract Introduction The aim of this study was to analyze the complication rates and mortality in association with different operative techniques of percutaneous endoscopic gastrostomy (PEG), age, underlying diseases and other risk factors. Moreover, analysis of the indications of PEG insertion and the underlying comorbidities was also performed. Methods This study performs a literature analysis of PEG-related complications in children. Literature was searched on PubMed® (1994–2017) using terms “percutaneous endoscopic gastrostomy”, “complications”, “mortality” and “children”. Results Eighteen articles with 4631 patients were analyzed. The mean age was 3 years (0–26 years). Operative techniques were: pull technique in 3507 (75.7%), 1 stage PEG insertion in 449 (9.7%), introducer technique in 435 (9.4%), image-guided technique in 195 (4.2%) and laparoscopic-assisted PEG in 45 (1.6%). Most frequent indications for PEG insertion were dysphagia (n = 859, 32.6%), failure to thrive (n = 723, 27.5%) and feeding difficulties (n = 459,17.4%). Minor complications developed in n1518 patients (33%), including granulation (n = 478, 10.3%), local infection (n = 384, 8.3%) and leakage (n = 279, 6%). In 464 (10%) patients, major complications occurred; the most common were systemic infection (n = 163, 3.5%) and cellulitis (n = 47, 1%). Severe complication like perforation occurred in less than 0.3%. Patients with lethal outcomes (n = 7, 0.15%) had severe comorbidities; and the cause of mortality was sepsis in all cases. Prematurity or young age did not affect complication rate. Patients with ventriculoperitoneal (VP) shunt had higher risk of major complications. In high-risk patients, laparoscopic-assisted PEG insertion had less major and severe complication than traditional pull technique. Conclusions PEG is a safe operative technique; although minor complications are relatively common and occur in up to 1/3 of patients, there is a fairly low rate of severe complications. Two-thirds of PEG patients have at least one comorbidity. Patients with VP shunt have higher risk of major complications. In high-risk patients, laparoscopic-assisted PEG is recommended. Keywords Children · Complications · Percutaneous endoscopic gastrostomy
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12519-018-0206-y) contains supplementary material, which is available to authorized users. * Brigitta Balogh [email protected] 1
Division of Pediatric Surgery, Department of Pediatrics, University of Szeged, Korányi fasor 14‑15, Szeged 6725, Hungary
Department of Pediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster NHS Fdn Trust, Imperial College London, London, UK
2
Childhood
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