Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Surgery. 2012 Oct;152(4):714-9; discussion 719-21. doi: 10.1016/j.surg.2012.07.018. Epub 2012 Aug 31.
Percutaneous endoscopic gastrostomy (PEG) placement in children has come under scrutiny with reports of improved safety profiles using laparoscopic-assisted techniques. However, these reports are generally limited by their retrospective nature and the inclusion of historically determined PEG complication rates in children. Complication rates associated with PEG placement in children have not been prospectively studied, and a true modern understanding of the safety profile of PEG when performed in children is unknown. We prospectively followed children undergoing PEG to establish a clear and current understanding of the complication rates associated with this procedure.
Consecutive PEG procedures performed between December 2009 and August 2010 at a single, tertiary-care pediatric hospital were enrolled for study. Patients were followed prospectively for 90 days with data regarding complications acquired via standardized interviews at 7, 30, and 90 days postoperatively.
We enrolled 103 patients for study. Median age and weight at time of operation was 8 months (range, 2 weeks-21 years) and 6.9 kg (range, 2-42). Patients underwent primary placement of either a PEG button (n = 70) or PEG tube (n = 33). There were no intraoperative complications, with a 100% procedure completion rate. Six deaths occurred during this follow-up time period (mean of 37 days postoperatively) and were attributed to causes other than PEG placement. Four patients were lost to follow-up. One PEG tube was electively discontinued before the end of the follow-up period without complication. Of the remaining 92 patients with complete data, 13 complications were observed in 10 patients. Total complication rate was 14%.
Rates of PEG complications observed in this prospective study are low and are generally minor. Observed rates of PEG-specific complications are lower than historic reports. The safety profile of PEG when performed in today's pediatric population remains comparable in safety to techniques such as laparoscopic-assisted gastrostomy.
经皮内镜胃造口术（PEG）在儿童中的应用受到了关注，有报道称使用腹腔镜辅助技术可以提高安全性。然而，这些报告通常受到其回顾性性质的限制，并且包括了历史上确定的儿童 PEG 并发症发生率。儿童 PEG 置管的并发症发生率尚未前瞻性研究，并且对于在儿童中进行 PEG 时的安全性概况也没有一个真正现代的了解。我们前瞻性地随访接受 PEG 的儿童，以明确和当前了解与该手术相关的并发症发生率。
在一家单中心三级儿科医院，于 2009 年 12 月至 2010 年 8 月期间连续进行的 PEG 手术被纳入研究。通过标准化访谈在术后 7、30 和 90 天获得有关并发症的数据，对患者进行了 90 天的前瞻性随访。
我们纳入了 103 名患者进行研究。手术时的中位年龄和体重为 8 个月（范围，2 周-21 岁）和 6.9kg（范围，2-42）。患者行 PEG 按钮（n=70）或 PEG 管（n=33）的初次置管。无术中并发症，手术完成率为 100%。在这段随访期间，有 6 例死亡（术后平均 37 天），归因于 PEG 置管以外的原因。4 名患者失访。1 名 PEG 管在随访结束前因并发症而被选择性地停用。在 92 名具有完整数据的患者中，有 10 名患者观察到 13 种并发症。总并发症发生率为 14%。
在这项前瞻性研究中观察到的 PEG 并发症发生率较低，且通常为轻微并发症。观察到的 PEG 特异性并发症发生率低于历史报告。在当今的儿科人群中进行 PEG 时的安全性与腹腔镜辅助胃造口术等技术相比仍然相当安全。
