Abstract

Aims: The experience on pediatric percutaneous endosco- pic gastrostomy (PEG) applications is relatively limited in children in our country. An audit regarding PEG indicati- ons, complications, outcome and follow up is presented.

Material and Methods: Beginning with the first case, a retrospective review of all children who underwent a PEG application was conducted by patient files, follow up re- cords and telephone interviews for the most current data.

Results: During a 44-month period, 26 PEG applications were done in 25 children. There were 11 males and 14 fe- males. The median age was 76 months (range, 8 months-14 years). The most frequent indication for PEG insertion was chronic neurological disease (n=18) followed by intracra- nial tumors (n=6) and cleft palate (n=1). All procedures were done under general anesthesia in the operating suit. No early postoperative complications were encountered. Feeding through the catheter was initiated in the3rd posto- perative day in all. The mean postoperative follow up was 13 months (range, 1,5-44 months). No procedure related deaths occurred; 10 children died of underlying disorders on an average of 8 months after PEG insertion. Among the remaining children, the catheter was removed in 2 after a mean of 9 months as the oral feeding was re-established. In one patient, a gastrocolic fistula was detected 4 months after PEG insertion. In an elective laparotomy, a Stamm gastrostomy was performed. In another one an open fun- doplication with gastrostomy was done 5 months later. The remaining 11 children are alive and actively using the PEG catheters. Among these, one patient had a gross leakage at the gastrostomy site that cannot be managed conservati- vely. He underwent a second PEG insertion with removal of the first one.

Conclusions: PEG offers the advantages of being a mi- nimally invasive procedure, being easy to care for and enabling a permanent access for enteral nutrition in han- dicapped children. Regarding its simplicity, effectiveness and reproducibility, PEG should be the first-line method for providing long-term artificial enteral nutrition and de- finitely deserves every effort to be used more widely in our country.