Percutaneous endocopic gastrostomy in children

Should single-stage PEG buttons become the procedure of choice for PEG placement in children?

BACKGROUND

Single-stage PEG buttons (PEG-B) allow initial placement of a skin-level gastrostomy device for children who require enteral access. They offer significant advantages over traditionally placed PEG tubes (PEG-T) but have not been widely accepted into practice.

OBJECTIVE

To review our experience with PEG-Bs compared with PEG-Ts.

HYPOTHESIS

PEG-B shares a similar safety profile with PEG-T but delays the need for an initial device change well beyond the change that usually occurs at 6 to 8 weeks after PEG-T placement.

DESIGN

Retrospective chart review.

SETTING

Nemours Children's Clinic, Jacksonville, Florida.

PATIENTS

All children undergoing both PEG procedures and attending our clinic from 1997 to 2002.

MAIN OUTCOME MEASUREMENTS

Age, sex, weight, indications, postoperative complications, interval until first tube change and first tube change complications.

RESULTS

Totals of 145 and 93 patients were identified in the PEG-B and PEG-T groups, respectively. Patient characteristics were similar in the 2 groups with respect to age, weight, indications, and postoperative complications. The interval until first tube change, however, was significantly longer in the PEG-B group (314 days) than in the PEG-T (78 days) (P < .0001). In addition, the PEG-B was found to be as safe as the PEG-T for small infants who weighed less than 5 kg.

CONCLUSIONS

PEG-B placement should be considered as the procedure of choice over PEG-T placement for children. It offers similar safety profiles, even for small patients and a significantly longer interval until first device change.