title: Percutaneous endoscopic gastrostomy placement in a human immunodeficiency virus-positive pediatric population leads to an increase in minor complications.
abstract: OBJECTIVE
  The development of effective multiple drug regimens for treating human immunodeficiency virus (HIV) are associated with nonadherence in children. HIV-positive children also have a higher incidence of malnutrition. Placement of a percutaneous endoscopic gastrostomy (PEG) is a potential solution. Primary outcome was to determine the complications of PEG placement in a pediatric HIV-positive population.
  
  
  METHODS
  A 10 year retrospective data analysis was carried out on all HIV-positive children undergoing insertion of a PEG at two institutions. Parameters examined included infections, leakage, displacement, reasons for removal, total time in situ, HIV stage, CD4 count, and serological investigation. Data were compared against published data for PEG insertion in pediatric oncology patients and other comparable pediatric series using Fisher's exact test.
  
  
  RESULTS
  Eighteen children were identified, with a median age 35 months and follow-up of 62 months. The majority of patients had advanced disease (Stage C; 65%). Fifty percent of PEGs were inserted for feeding supplementation and all were used for the administration of medications. Sixty-one percent experienced a minor complication; 5/18 (27.7%) experienced peristomal infection; 2/18 (11.1%) experienced either bleeding, leakage, or excessive granulation; and 1/18 (5.6%) experienced dislodgement. Stage of HIV did not affect the incidence of bleeding or infection: 5/11(Stage C) versus 2/7(Stage B) (P = .3). There was no significant difference for major complications when compared with any series though comparison with a large pediatric series revealed a significant difference for minor complications 11/18 versus 27/120 (P = .0003).
  
  
  CONCLUSIONS
  There is a low rate of serious complications with PEG insertion in our patients, and the rate is comparable to that seen in pediatric oncology patients. The minor complication rate is, however, higher than a nonimmune compromised population; and careful follow-up for these patients is recommended so that the appropriate therapy can be promptly initiated.
authors.affiliation: Department of Paediatric Surgery, Chelsea & Westminster Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Ramesh M
authors.initials: RM
authors.lastname: Nataraja
authors.forename: Julia R
authors.initials: JR
authors.lastname: Fishman
authors.forename: Aisha
authors.initials: A
authors.lastname: Naseer
authors.forename: Jo
authors.initials: J
authors.lastname: Dodge
authors.forename: Sam M D
authors.initials: SM
authors.lastname: Walters
authors.forename: Simon A
authors.initials: SA
authors.lastname: Clarke
authors.forename: Munther J
authors.initials: MJ
authors.lastname: Haddad
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D015658:HIV Infections / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D009752:Nutritional Status; D012189:Retrospective Studies; D016896:Treatment Outcome