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Indications for Percutaneous Endoscopic Gastrostomy and Procedure-related Outcome

Srinivasan, Ramesh; Irvine, Tracey; Dalzell, Mark

Journal of Pediatric Gastroenterology & Nutrition: November 2009 - Volume 49 - Issue 5 - p 584–588
doi: 10.1097/MPG.0b013e31819a4e8c
Original Articles: Gastroenterology

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.

Department of Paediatric Gastroenterology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, UK

Received 25 September, 2008

Accepted 17 December, 2008

Address correspondence and reprint requests to Dr Ramesh Srinivasan, Specialist Registrar in Paediatric Gastroenterology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK (e-mail:

The authors report no conflicts of interest.

© 2009 Lippincott Williams & Wilkins, Inc.