Gut Interactions with Brain and Environment in Children; First International Symposium on Pediatric Neurogastroenterology Capri, Italy, September 18-20, 1997
It has been demonstrated that an adequate nutritional intake allows a rapid recovery of the growth curve in young children. Percutaneous endoscopic gastrostomy (PEG) is an established standard procedure and preferred method for artificial long-term intestinal nutrition. This technique leads to an adequate nutritional intake, normalizing the metabolic pattern to overcome difficulties related with anorexia, swallowing problems, easy muscolar exhaustion, malabsorption, and safe administration of drugs necessary to neurologically damaged children. The principal complication related to the PEG is the gastroesophageal reflux (GER). This side effect can be significantly reduced modifying the original procedure: gastrostomy is now positioned in the gastric antrum and the exit site is located on the right side of the abdomen. This to enforce the anatomical antireflux system, especially the His angle. We call this modification “the Right-PEG”. The aim of the study is to evaluate the presence of GER in children with Right-PEG: preoperative investigations and follow-up included 24 hours-pHtonometry and esophageal biopsies. Since 1994 at our Institution performed 52 Right-PEG for long-term enteral access in children aged between 4 months and 20 years (average 3.9 years), weight from 4.1 to 40 Kg (average 12.9 Kg). No immediate surgical complication. At the follow-up the 24 hours-pHtonometry showed presence of GER in 5.7%; however none of the children was symptomatic. Grade 2 esophagitis was found preoperatively in 9.6% of the cases, and persisted at the follow-up. The improved nutritional conditions reached with the R-PEG technique allows the child fed again by mouth, improve the immune defences, and reduce the respiratory infections.