PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN CHILDREN ON PERITONEAL DIALYSIS

• Published in: Peritoneal dialysis international Vol. 26; no. 1; pp. 69 - 77
• Main Authors: von Schnakenburg, Christian, Feneberg, Reinhard, Plank, Christian, Zimmering, Miriam, Arbeiter, Klaus, Bald, Martin, Fehrenbach, Henry, Griebel, Martin, Licht, Christoph, Konrad, Martin, Timmermann, Kirsten, Kemper, Markus J
• Format: Journal Article
• Language: English
• Published: Milton, ON Multimed 01.01.2006
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Child, Preschool; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Gastroscopy; Gastrostomy - methods; Glomerulonephritis; Humans; Infant; Infant, Newborn; Intensive care medicine; Kidney Failure, Chronic - therapy; Male; Malnutrition - therapy; Medical sciences; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Peritoneal Dialysis - adverse effects; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Time Factors; Treatment Outcome; Human; Kidney disease; Gastrostomy; Urinary system disease; Peritoneal dialysis; Percutaneous route; Enteral feeding; Infection; Extrarenal dialysis; fungal infection; Abdominal disease; Renal failure; Endoscopy; percutaneous endoscopic gastrostomy; Child; Peritonitis
• ISSN: 0896-8608; 1718-4304
• DOI: 10.1177/089686080602600111

Department for Pediatrics and Adolescent Medicine, 1 University Hospital Freiburg, Freiburg, Germany; Arbeitsgemeinschaft für Pädiatrische Nephrologie, 2 (APN) Correspondence to: C. von Schnakenburg, Department for Pediatrics and Adolescent Medicine, University Hospitals, Mathildenstrasse 1, D-79106 Freiburg, Germany. christian.schnakenburg{at}uniklinik-freiburg.de Objective: Insertion of percutaneous endoscopic gastrostomies (PEG) in patients on chronic peritoneal dialysis (PD) has been reported to be contraindicated due to an increased risk of morbidity and mortality. However, no systematic survey on this topic has yet been published. Design: Retrospective multicenter study. Setting: 23 pediatric dialysis units associated with the working group Arbeitsgemeinschaft für Pädiatrische Nephrologie (APN). Data Source: A structured questionnaire on clinical details of PD patients who had undergone PEG insertion or open gastrostomy (OG) since 1994 was distributed to all pediatric dialysis units of the APN. Results: 27 PD patients (20 males) from 12 centers in whom PEG insertion was performed after Tenckhoff catheter introduction were evaluated. Age at intervention ranged from 0.25 to 10.9 years (median 1.3 years). Most patients were malnourished, with standard deviation score (SDS) for body weight between –4.2 and –0.6 (median–2.2). Major complications were early peritonitis <7 days after PEG in 10/27 (37%) patients, episodes of fungal peritonitis in 7/27 (26%) patients, 4 cessations of PD and change to hemodialysis, and 2 associated deaths. However, in 14 patients, no such problems were encountered and, in 4 patients, early peritonitis effectively treated with intraperitoneal antibiotics was the only major complication. Thus, in 18/27 (67%) patients, PD was successfully reinitiated shortly after PEG insertion. Among all participating centers, only two OG procedures were reported during the study period, illustrating a clear preference for the PEG over the OG procedure among members of the APN. Conclusion: PEG insertion following PD initiation carries a high risk for fungal peritonitis and potential PD failure; however, complication rates in this largest reported series were lower than previously described. Antibiotic and antifungal prophylaxis, withholding PD for 2 – 3 days, and gastrostomy placement by an experienced endoscopy team are suggested precautions for lowering the risk of associated complications. When gastrostomy placement does not occur prior to or at the time of initiating PD, the risks and benefits of percutaneous versus open placement must be carefully weighed. KEY WORDS: Enteral feeding; gastrostomy; peritonitis; percutaneous endoscopic gastrostomy; fungal infection. Received 29 November 2004; accepted 27 May 2005.