title: Indications for percutaneous endoscopic gastrostomy and procedure-related outcome.
abstract: OBJECTIVE
  : To describe the indications and practice of percutaneous endoscopic gastrostomy (PEG) device insertion for nutritional support and to ascertain procedure-related complications and outcome.
  
  
  METHODS
  : Observational study with prospectively collected data on children who underwent PEG-related procedures (PEG insertion, removal, or change to low profile button devices [LPBD]) for a 5-year period (2002-2006) at our centre.
  
  
  RESULTS
  : Six hundred one PEG-related procedures were performed during the study period (384 insertions, 165 conversions to LPBD, 49 permanent PEG removals, and 3 PEG reinsertions). The main indications for PEG insertion were feeding difficulties associated with neurodisability (160/384; 41.6%) and congenital heart disease (CHD 115/384; 30%). Children with CHD required feeding nutritional support at an earlier age than children with neurodisability regardless of underlying cardiac condition. The age of PEG insertion was significantly different between the 2 main groups (neurodisability 3.56 years vs CHD 0.39 years; P < 0.001 [t test]). Fifty-nine patients were discharged on the same day as PEG insertion without complications (day case gastrostomy). The median time between PEG insertion to LPBD conversion was 0.83 year (0.12-3.86). Twenty-four of the 49 children having permanent PEG removal had CHD.
  
  
  CONCLUSIONS
  : Neurodisabilty and CHD were the main indications for PEG insertion, those with CHD requiring feeding support at an earlier age. Although CHD was an indication for PEG insertion in 30% of instances, a greater percentage of PEG removals (50%) were seen in this group indicating resolution of feeding difficulties.
authors.affiliation: Department of Paediatric Gastroenterology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, UK. ramsriniv@doctors.org.uk
authors.forename: Ramesh
authors.initials: R
authors.lastname: Srinivasan
authors.forename: Tracey
authors.initials: T
authors.lastname: Irvine
authors.forename: Mark
authors.initials: M
authors.lastname: Dalzell
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002547:Cerebral Palsy; D002648:Child; D002675:Child, Preschool; D006233:Persons with Disabilities; D004724:Endoscopy / Q000379:methods*; D005774:Gastrostomy / Q000295:instrumentation* / Q000379:methods; D006331:Heart Diseases / Q000151:congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal / Q000295:instrumentation* / Q000379:methods; D009422:Nervous System Diseases / Q000628:therapy*; D018529:Nutritional Support / Q000295:instrumentation* / Q000379:methods; D019370:Observation; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult