title: Long-term outcomes of infants and children undergoing percutaneous endoscopy gastrostomy tube placement.
abstract: OBJECTIVE
  Little is known about long-term outcomes of patients undergoing percutaneous endoscopic gastrostomy (PEG) placement. The purpose of this study was to examine tube-related major complications in pediatric patients undergoing PEG placement during a 10-year follow-up period.
  
  
  METHODS
  A retrospective chart review of patients undergoing PEG placement from April 1999 through December 2000 at Boston Children's Hospital was performed. Cumulative incident rates of major complications (defined by additional hospitalization, surgical or interventional radiology procedures) as well as time between PEG placement and major complications were evaluated using Kaplan-Meier survival analysis. Time to elective tube removal and patient mortality was also assessed.
  
  
  RESULTS
  One hundred thirty-eight patients (59% [n = 82] boys [median age 22.5 months] [interquartile range, IQR 9-72.5], weight 9.2 kg [IQR 6.1-15.8]), underwent PEG placement during the study period and were followed at our hospital for a median of 4.98 years (IQR 1.5-8.7) years. Median time to elective tube removal was 10.2 years, with approximately half of the patients estimated to still have an indwelling enteral tube 10 years after placement. Fifteen patients (11%) had at least 1 major complication related to their gastrostomy tubes during the examined time period. The cumulative incidence of patients having a major complication was 15% (95% confidence interval 8.9-24.5) by 5.4 years.
  
  
  CONCLUSIONS
  Children undergoing PEG placement have a long-term high risk of morbidity related to enteral tubes. Major complications can occur many years after PEG placement. Larger prospective studies may be useful to assess risk factors for PEG-related complications in pediatrics.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Maireade E
authors.initials: ME
authors.lastname: McSweeney
authors.forename: Hongyu
authors.initials: H
authors.lastname: Jiang
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Deutsch
authors.forename: Melissa
authors.initials: M
authors.lastname: Atmadja
authors.forename: Jenifer R
authors.initials: JR
authors.lastname: Lightdale
mesh_terms: D001900:Boston / Q000453:epidemiology; D046688:Child Mortality; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D004750:Enteral Nutrition / Q000009:adverse effects*; D019959:Feeding and Eating Disorders of Childhood / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000009:adverse effects*; D005774:Gastrostomy / Q000009:adverse effects*; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis