Kidder Molly, Phen Claudia, Brown Jerry, Kimsey Kathryn, Oshrine Benjamin, Ghazarian Sharon, Mateus Jazmine, Amankwah Ernest, Wilsey Michael
Department of Pediatrics, University of South Florida Health, Tampa, FL, USA.
Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Pediatr Gastroenterol Hepatol Nutr. 2021 Nov;24(6):546-554. doi: 10.5223/pghn.2021.24.6.546. Epub 2021 Nov 5.
Malnutrition is a significant issue for pediatric patients with cancer. We sought to evaluate the effectiveness and complication rate of percutaneous endoscopic gastrostomy (PEG) placement in pediatric oncology patients.
A retrospective chart review was performed on 49 pediatric oncology patients undergoing PEG placement at Johns Hopkins All Children's Hospital between 2000 and 2016. Demographic and clinical characteristics, complications, absolute neutrophil count at time of PEG placement and at time of complications, length of stay, and mortality were identified. Weight-for-age Z-scores were evaluated at time of- and six months post-PEG placement.
The overall mean weight-for-age Z-score improved by 0.73 (<0.0001) from pre- (-1.11) to post- (-0.38) PEG placement. Improvement in Z-score was seen in patients who were malnourished at time of PEG placement (1.14, <0.0001), but not in those who were not malnourished (0.32, =0.197). Site infections were seen in 12 (24%), buried bumper syndrome in five (10%), and tube dislodgement in one (2%) patient. One patient (2%) with fever was treated for possible peritonitis. There were no cases of other major complications, including gastric perforation, gastrocolic fistula, clinically significant bleeding, or PEG-related death documented.
Consistent with previous studies, our data suggests a relationship between site complications (superficial wound infection, buried bumper syndrome) and neutropenia. Additionally, PEG placement appears to be an effective modality for improving nutritional status in malnourished pediatric oncology patients. However, larger prospective studies with appropriate controls and adjustment for potential confounders are warranted to confirm these findings.
营养不良是癌症儿科患者的一个重要问题。我们试图评估经皮内镜下胃造口术（PEG）在儿科肿瘤患者中的有效性和并发症发生率。
对2000年至2016年间在约翰霍普金斯全儿童医院接受PEG置入术的49例儿科肿瘤患者进行回顾性病历审查。确定了人口统计学和临床特征、并发症、PEG置入时和并发症发生时的绝对中性粒细胞计数、住院时间和死亡率。在PEG置入时和置入后六个月评估年龄别体重Z评分。
年龄别体重Z评分总体均值从PEG置入前的（-1.11）提高到置入后的（-0.38），提高了0.73（<0.0001）。PEG置入时营养不良的患者Z评分有所改善（1.14，<0.0001），但未营养不良的患者则无改善（0.32，=0.197）。12例（24%）出现局部感染，5例（10%）出现埋藏式胃造口管综合征，1例（2%）出现造瘘管移位。1例（2%）发热患者因可能的腹膜炎接受治疗。未记录到其他重大并发症的病例，包括胃穿孔、胃结肠瘘、具有临床意义的出血或与PEG相关的死亡。
与先前的研究一致，我们的数据表明局部并发症（浅表伤口感染、埋藏式胃造口管综合征）与中性粒细胞减少之间存在关联。此外，PEG置入似乎是改善营养不良的儿科肿瘤患者营养状况的一种有效方式。然而，需要进行更大规模的前瞻性研究，并进行适当的对照和对潜在混杂因素的调整，以证实这些发现。
