Percutaneous Endoscopic Gastrostomy (PEG) in Children

Introduction

Percutaneous endoscopic gastrostomy (PEG) is a medical procedure that involves the placement of a flexible feeding tube through the abdominal wall and into the stomach. This procedure is often performed in children who have difficulty swallowing or eating due to various medical conditions, such as neurological disorders, congenital anomalies, or cancer.

Indications

The indications for PEG in children include:

• Neurological disorders, such as cerebral palsy or muscular dystrophy
• Congenital anomalies, such as esophageal atresia or tracheoesophageal fistula
• Cancer or tumors affecting the head and neck
• Gastroesophageal reflux disease (GERD) that is unresponsive to medical therapy
• Failure to thrive due to inadequate nutrition

Contraindications

The contraindications for PEG in children include:

• Presence of intrauterine shunts or other abdominal shunts
• Previous abdominal surgery that may interfere with the placement of the tube
• Active peritonitis or intra-abdominal infection
• Ascites or presence of fluid in the abdominal cavity

Procedure

The PEG procedure is typically performed under general anesthesia or conscious sedation. The steps involved are:

1. The child is positioned on their back and the abdomen is cleaned and prepared with antiseptic solution.
2. An endoscope is inserted through the mouth and guided into the stomach.
3. A small incision is made in the abdominal wall, and a guidewire is passed through the incision and into the stomach under endoscopic guidance.
4. The feeding tube is then threaded over the guidewire and into the stomach.
5. The internal bumper of the tube is secured against the stomach wall, and the external bumper is secured against the abdominal wall.

Post-Procedure Care

After the procedure, the child will require:

• Pain management with analgesics as needed
• Monitoring for signs of infection or bleeding
• Gradual introduction of feedings through the tube, starting with small amounts and gradually increasing the volume and concentration
• Regular cleaning and maintenance of the tube to prevent clogging and infection

Complications

Possible complications of PEG in children include:

• Infection or abscess formation at the site of the tube
• Bleeding or hematoma formation
• Perforation of the stomach or intestine
• Leakage of feedings around the tube
• Clogging or blockage of the tube

Long-Term Care and Follow-Up

Children with a PEG tube will require regular follow-up appointments with their healthcare provider to:

• Monitor the function and patency of the tube
• Assess for signs of infection or other complications
• Adjust the feeding regimen as needed
• Plan for eventual removal of the tube when it is no longer needed