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.