title: Complications following percutaneous endoscopic gastrostomy and subsequent catheter replacement in children and young adults.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy has gained wide acceptance for patients who require prolonged tube feeding support. We sought to identify complications and associated risk factors of endoscopic gastrostomy and subsequent catheter replacement in pediatric patients.
  
  
  METHODS
  Medical records were reviewed for 137 patients. Odds ratios were calculated for complications related to patient age, weight, weight-for-age Z score, and principal diagnosis.
  
  
  RESULTS
  Seventeen patients (12.4%) developed significant complications after gastrostomy: cellulitis occurred in 10 patients (7.3%); other complications included gastrocolic fistula (2), duodenal hematoma (1), complicated pneumoperitoneum (1), necrotizing fasciitis (1), gastric perforation (1), and catheter migration (1). Patients with cancer had significantly greater odds for developing a wound infection, and patients with AIDS had significantly greater odds for total complications. A trend toward increased wound infection was observed in patients with cardiac disease. Age, weight, and weight-for-age Z score were not associated with adverse outcome. Two complications occurred in 85 patients (2.4%) after gastrostomy catheter replacement.
  
  
  CONCLUSIONS
  Pediatric patients with cancer and AIDS are at increased risk for complications after endoscopic gastrostomy regardless of age, weight, or nutritional status. Infrequent yet life-threatening complications may occur after replacement of initial gastrostomy catheter.
authors.affiliation: Combined Program in Pediatric Gastroenterology and Nutrition, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: V L
authors.initials: VL
authors.lastname: Fox
authors.forename: S D
authors.initials: SD
authors.lastname: Abel
authors.forename: S
authors.initials: S
authors.lastname: Malas
authors.forename: C
authors.initials: C
authors.lastname: Duggan
authors.forename: A M
authors.initials: AM
authors.lastname: Leichtner
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002408:Catheters, Indwelling; D002481:Cellulitis / Q000209:etiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods; D004868:Equipment Failure; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D020699:Gastroscopes; D005773:Gastroscopy / Q000009:adverse effects* / Q000379:methods; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000601:surgery; D016017:Odds Ratio; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology