PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN PEDIATRICS. LITERATURE REVIEW

Abstract

Introduction: Percutaneous endoscopic gastrostomy (PEG) is a common procedure performed worldwide in
patients with a variety of comorbidities, with multiple indications. Although the procedure is considered generally safe,
life-threatening complications can sometimes occur. The purpose of this review is to analyze endoscopic percutaneous
access techniques and determine the frequency of associated complications.
Methods: analytical review of the literature on main complications associated with PEG in children. A literatu re
search was conducted in PubMed, CyberLeninck, and Elibrary databases using the keywords “percutaneous
endoscopic gastrostomy,” “complications,” and “children.” The depth of the search was 10 years.
Results: Thirteen articles with 2009 pediatric patients were analyzed. The most common PEG methods are Pull
and Push. Pull method was performed in 29.9% of patients and Push method in 48.7%. In 21.4% of patients, the
method of PEG was not specified in the publications. Dysphagia of neurologic origin was the main indication followed
by the need for nutritional support in different diseases. A total of 1505 complications were reported, of which 1370
(91.0%) were minor complications and 135 (9.0%) were major complications. Hypergranulation was the most frequent
minor complication, followed by leakage of gastric contents through the gastrostomy site, peristomal infections,
dislocation and early exit of the gastrostomy tube. Among the serious complications, gastric heterotopia was the most
frequent in one-stage Button PEG. Peritonitis, gastrointestinal bleeding, hidden bumper syndrome, gastrointestinal
fistula and bowel obstruction were next in frequency. Perforation of esophagus, stomach and intestine occurred in 2
cases each. Fatal outcome was reported in 2 patients, the cause of death was sepsis after perforation of the
esophagus and gastrointestinal fistula formation.
Conclusion: Children undergoing percutaneous endoscopic gastrostomy often have minor complications. PEG
has a low incidence of major complications and mortality.