Percutaneous Endoscopic Gastrostomy and Gastrojejunostomy in Psychomotor Retarded Subjects: A Follow-Up Covering 106 Patient Years

Background Whether psychomotor retarded persons should be treated by percutaneous endoscopic gastrostomy (PEG) or by surgical gastrostomy combined with an antireflux procedure is controversial. Therefore, the authors investigated the feasibility of a PEG and enteral feeding in these patients. Methods Patients referred from specialized institutions for a PEG placement were assessed extensively by a multidisciplinary team. When considered eligible, age and general condition determined the choice of treatment under general anesthesia (group 1) or conscious sedation (group 2). Patients were followed up after 1 and 7 days, 4 and 12 weeks, and thereafter every 6 to 12 weeks. Data were collected prospectively over a period of 5 years until gastrostomy removal, death, or arrival at the censory date, 6 months after PEG placement. The endpoints were 1) to evaluate the procedure and its complications; 2) to discover barriers that impeded adequate nutrition; and 3) to explore the appropriateness of the choice of PEG or percutaneous endoscopic gastrojejunostomy (PEJ). Results The procedure was successful in 95% of patients, in every patient in group 1 (35/35; median age, 4.1 years) and in 20 of 23 patients (87%) in group 2 (median age, 22.0 years). There were no procedure-related deaths and no 30-day mortality. Major complications changed from procedure-related problems in the short term (5.4%) to tube-related problems in the long-term (24.1%). Nausea and vomiting interfered with adequate feeding mainly in young children, but dietary adjustments alleviated the symptoms and ensured an adequate intake. The choice of a PEG was incorrect in four patients: surgery was needed twice and two PEGs had to be converted into a PEJ. All seven primarily indicated PEJs seemed justified and of temporary need in five. Conclusions In severely disabled patients, a PEG and adequate enteral nutrition is feasible in the setting of a multidisciplinary approach and protocol-wise follow-up. Yet, anatomic deformities and restricted pulmonary function rendered the procedure more difficult. In cases with obvious aspiration or gastroesophageal reflux, a PEJ combined with acid suppression and prokinetic drugs may be tried before surgery.