Endoscopic gastrostomy and gastro-oesophageal reflux in children with severe neurological deficit
The objective. Study the frequency of complications of percutaneous endoscopic gastrostomy (PEG), including gastro-oesophageal reflux (GOR), to justify indications and contraindications to performing the procedure. Patients and methods. A group of 20 patients with PEG was examined. The group comprised 12 boys and 8 girls, the mean age was 2.9 ± 0.6 years (from 4 months to 12 years), mean body weight - 6.5 ± 0.7 kg (from 3.5 to 25 kg). All children, prior to administration of PEG procedure, underwent diagnostic video oesophagogastroduodenoscopy (VOGDS) and examination in the FICE mode. Results. Before PEG procedure, mild gastro-oesophageal reflux had been found in 5 patients, moderate GOR in 12 children, severe GOR in 3 children. The number of complications did not exceed the incidence described by other authors: gastrointestinal fistula - in 1 patient, gastric ulcer against the background of the «bumper» syndrome - in 1 patient. No worsening was observed after PEG in patients with absent clinical manifestations of GOR in case of following recommendations for patients' care. In children with moderate GOR, no dynamic changes were found in three children, in 8 improvement was obtained which was manifested by a significant decrease or disappearance of clinical symptoms. Of three children with severe reflux after placement of a gastrostomy tube in two children improvement was obtained. Conclusion. PEG is a low-invasive procedure, with short duration and a short post-operative period. Placement of PEG facilitates care for children with marked neurological deficit. This procedure does not aggravate the course of mild or moderate GOR, except for children with diagnosed oesophageal hiatic diaphragmatic hernia.