Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Effectiveness and Complication Rate of Percutaneous Endoscopic Gastrostomy Placement in Pediatric Oncology Patients

  • Kidder, Molly (Department of Pediatrics, University of South Florida Health) ;
  • Phen, Claudia (Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern Medical Center) ;
  • Brown, Jerry (Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children's Hospital) ;
  • Kimsey, Kathryn (Department of Pediatric Gastroenterology and Nutrition, Johns Hopkins All Children's Hospital) ;
  • Oshrine, Benjamin (Department of Pediatric Hematology/Oncology, Johns Hopkins All Children's Hospital) ;
  • Ghazarian, Sharon (Epidemiology and Biostatistics, Johns Hopkins All Children's Institute for Clinical and Translational Research) ;
  • Mateus, Jazmine (Epidemiology and Biostatistics, Johns Hopkins All Children's Institute for Clinical and Translational Research) ;
  • Amankwah, Ernest (Department of Pediatric Hematology/Oncology, Johns Hopkins All Children's Hospital) ;
  • Wilsey, Michael (Department of Pediatrics, University of South Florida Health)
  • Received : 2021.06.09
  • Accepted : 2021.08.17
  • Published : 2021.11.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Malnutrition is a significant issue for pediatric patients with cancer. We sought to evaluate the effectiveness and complication rate of percutaneous endoscopic gastrostomy (PEG) placement in pediatric oncology patients. Methods: A retrospective chart review was performed on 49 pediatric oncology patients undergoing PEG placement at Johns Hopkins All Children's Hospital between 2000 and 2016. Demographic and clinical characteristics, complications, absolute neutrophil count at time of PEG placement and at time of complications, length of stay, and mortality were identified. Weight-for-age Z-scores were evaluated at time of- and six months post-PEG placement. Results: The overall mean weight-for-age Z-score improved by 0.73 (p<0.0001) from pre- (-1.11) to post- (-0.38) PEG placement. Improvement in Z-score was seen in patients who were malnourished at time of PEG placement (1.14, p<0.0001), but not in those who were not malnourished (0.32, p=0.197). Site infections were seen in 12 (24%), buried bumper syndrome in five (10%), and tube dislodgement in one (2%) patient. One patient (2%) with fever was treated for possible peritonitis. There were no cases of other major complications, including gastric perforation, gastrocolic fistula, clinically significant bleeding, or PEG-related death documented. Conclusion: Consistent with previous studies, our data suggests a relationship between site complications (superficial wound infection, buried bumper syndrome) and neutropenia. Additionally, PEG placement appears to be an effective modality for improving nutritional status in malnourished pediatric oncology patients. However, larger prospective studies with appropriate controls and adjustment for potential confounders are warranted to confirm these findings.

Keywords

Acknowledgement

Funding provided by the Johns Hopkins All Children's Foundation.

References

  1. Robinson DL, Loman DG, Balakas K, Flowers M. Nutritional screening and early intervention in children, adolescents, and young adults with cancer. J Pediatr Oncol Nurs 2012;29:346-55. https://doi.org/10.1177/1043454212460921
  2. McGrath KH, Hardikar W. Gastrostomy tube use in children with cancer. Pediatr Blood Cancer 2019;66:e27702. https://doi.org/10.1002/pbc.27702
  3. Jones L, Watling RM, Wilkins S, Pizer B. Nutritional support in children and young people with cancer undergoing chemotherapy. Cochrane Database Syst Rev 2010;(7):CD003298.
  4. Ladas EJ, Sacks N, Brophy P, Rogers PC. Standards of nutritional care in pediatric oncology: results from a nationwide survey on the standards of practice in pediatric oncology. A Children's Oncology Group study. Pediatr Blood Cancer 2006;46:339-44. https://doi.org/10.1002/pbc.20435
  5. Brinksma A, Sanderman R, Roodbol PF, Sulkers E, Burgerhof JG, de Bont ES, et al. Malnutrition is associated with worse health-related quality of life in children with cancer. Support Care Cancer 2015;23:3043-52. https://doi.org/10.1007/s00520-015-2674-0
  6. Loeffen EA, Brinksma A, Miedema KG, de Bock GH, Tissing WJ. Clinical implications of malnutrition in childhood cancer patients--infections and mortality. Support Care Cancer 2015;23:143-50. https://doi.org/10.1007/s00520-014-2350-9
  7. Schmitt F, Caldari D, Corradini N, Gicquel P, Lutz P, Leclair MD, et al. Tolerance and efficacy of preventive gastrostomy feeding in pediatric oncology. Pediatr Blood Cancer 2012;59:874-80. https://doi.org/10.1002/pbc.24161
  8. Rogers PC, Melnick SJ, Ladas EJ, Halton J, Baillargeon J, Sacks N; Children's Oncology Group (COG) Nutrition Committee. Children's Oncology Group (COG) Nutrition Committee. Pediatr Blood Cancer 2008;50(2 Suppl):447-50; discussion 451. https://doi.org/10.1002/pbc.21414
  9. Trimpe K, Shaw MR, Wilson M, Haberman MR. Review of the effectiveness of enteral feeding in pediatric oncology patients. J Pediatr Oncol Nurs 2017;34:439-45. https://doi.org/10.1177/1043454217712982
  10. Williams-Hooker R, Adams M, Havrilla DA, Leung W, Roach RR, Mosby TT. Caregiver and health care provider preferences of nutritional support in a hematopoietic stem cell transplant unit. Pediatr Blood Cancer 2015;62:1473-6. https://doi.org/10.1002/pbc.25473
  11. Driver K, Schilling R, Goodwin A, Martinez D, Amankwah E, Shakeel F, et al. Safety and efficacy of bedside percutaneous endoscopic gastrostomy placement in the neonatal intensive care unit. J Pediatr Gastroenterol Nutr 2018;67:40-4. https://doi.org/10.1097/MPG.0000000000001906
  12. Khalaf RT, Green D, Amankwah EK, Peck J, Carr V, Goldenberg NA, et al. Percutaneous endoscopic gastrostomy tubes may be associated with preservation of lung function in patients with cystic fibrosis. Nutr Clin Pract 2019;34:290-6. https://doi.org/10.1002/ncp.10219
  13. Peck J, Mills K, Dey A, Nguyen ATH, Amankwah EK, Wilsey A, et al. Comparison of tolerance and complication rates between early and delayed feeding after percutaneous endoscopic gastrostomy placement in children. J Pediatr Gastroenterol Nutr 2020;70:55-8. https://doi.org/10.1097/mpg.0000000000002503
  14. Sochet AA, Grindy AK, Son S, Barrie EK, Hickok RL, Nakagawa TA, et al. Percutaneous endoscopic gastrostomy after cardiothoracic surgery in children less than 2 months old: an assessment of long-term malnutrition status and gastrostomy outcomes. Pediatr Crit Care Med 2020;21:50-8. https://doi.org/10.1097/pcc.0000000000002129
  15. Parbhoo DM, Tiedemann K, Catto-Smith AG. Clinical outcome after percutaneous endoscopic gastrostomy in children with malignancies. Pediatr Blood Cancer 2011;56:1146-8. https://doi.org/10.1002/pbc.22873
  16. Fortunato JE, Cuffari C. Outcomes of percutaneous endoscopic gastrostomy in children. Curr Gastroenterol Rep 2011;13:293-9. https://doi.org/10.1007/s11894-011-0189-5
  17. Minar P, Garland J, Martinez A, Werlin S. Safety of percutaneous endoscopic gastrostomy in medically complicated infants. J Pediatr Gastroenterol Nutr 2011;53:293-5. https://doi.org/10.1097/MPG.0b013e318215c41b
  18. Lalanne A, Gottrand F, Salleron J, Puybasset-Jonquez AL, Guimber D, Turck D, et al. Long-term outcome of children receiving percutaneous endoscopic gastrostomy feeding. J Pediatr Gastroenterol Nutr 2014;59:172-6. https://doi.org/10.1097/MPG.0000000000000393
  19. Buderus S, Sonderkotter H, Fleischhack G, Lentze MJ. Diagnostic and therapeutic endoscopy in children and adolescents with cancer. Pediatr Hematol Oncol 2012;29:450-60. https://doi.org/10.3109/08880018.2012.678568
  20. Pedersen AM, Kok K, Petersen G, Nielsen OH, Michaelsen KF, Schmiegelow K. Percutaneous endoscopic gastrostomy in children with cancer. Acta Paediatr 1999;88:849-52. https://doi.org/10.1080/08035259950168775
  21. Kaur S, Ceballos C, Bao R, Pittman N, Benkov K. Percutaneous endoscopic gastrostomy tubes in pediatric bone marrow transplant patients. J Pediatr Gastroenterol Nutr 2013;56:300-3. https://doi.org/10.1097/MPG.0b013e318279444c
  22. McSweeney ME, Kerr J, Jiang H, Lightdale JR. Risk factors for complications in infants and children with percutaneous endoscopic gastrostomy tubes. J Pediatr 2015;166:1514-9.e1. https://doi.org/10.1016/j.jpeds.2015.03.009
  23. Barron MA, Duncan DS, Green GJ, Modrusan D, Connolly B, Chait P, et al. Efficacy and safety of radiologically placed gastrostomy tubes in paediatric haematology/oncology patients. Med Pediatr Oncol 2000;34:177-82. https://doi.org/10.1002/(SICI)1096-911X(200003)34:3<177::AID-MPO3>3.0.CO;2-G
  24. Bakish J, Hargrave D, Tariq N, Laperriere N, Rutka JT, Bouffet E. Evaluation of dietetic intervention in children with medulloblastoma or supratentorial primitive neuroectodermal tumors. Cancer 2003;98:1014-20. https://doi.org/10.1002/cncr.11598
  25. Strong RM, Condon SC, Solinger MR, Namihas BN, Ito-Wong LA, Leuty JE. Equal aspiration rates from postpylorus and intragastric-placed small-bore nasoenteric feeding tubes: a randomized, prospective study. JPEN J Parenter Enteral Nutr 1992;16:59-63. https://doi.org/10.1177/014860719201600159
  26. Ricciuto A, Baird R, Sant'Anna A. A retrospective review of enteral nutrition support practices at a tertiary pediatric hospital: a comparison of prolonged nasogastric and gastrostomy tube feeding. Clin Nutr 2015;34:652-8. https://doi.org/10.1016/j.clnu.2014.07.007
  27. Hamilton EC, Curtin T, Slack RS, Ge C, Slade AD, Hayes-Jordan A, et al. Surgical feeding tubes in pediatric and adolescent cancer patients: a single-institution retrospective review. J Pediatr Hematol Oncol 2017;39:e342-8. https://doi.org/10.1097/MPH.0000000000000902
  28. Avitsland TL, Kristensen C, Emblem R, Veenstra M, Mala T, Bjornland K. Percutaneous endoscopic gastrostomy in children: a safe technique with major symptom relief and high parental satisfaction. J Pediatr Gastroenterol Nutr 2006;43:624-8. https://doi.org/10.1097/01.mpg.0000229550.54455.63
  29. Srinivasan R, Irvine T, Dalzell M. Indications for percutaneous endoscopic gastrostomy and procedurerelated outcome. J Pediatr Gastroenterol Nutr 2009;49:584-8. https://doi.org/10.1097/MPG.0b013e31819a4e8c
  30. Srinivasan R, O'Neill C, Blumenow W, Dalzell AM. Perceptions of caregivers following percutaneous endoscopic gastrostomy in children with congenitally malformed hearts. Cardiol Young 2009;19:507-10. https://doi.org/10.1017/S1047951109990680
  31. Grindy AK, Wilsey MJ, Hickok R, Nakagawa TA, Sochet AA. Percutaneous endoscopic gastrostomy enhances interstage growth in infants with hypoplastic left heart syndrome. Pediatr Crit Care Med 2021;22:e213-23. https://doi.org/10.1097/PCC.0000000000002596