J Med Assoc Thai 2002; 85 (11):1183

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Modified Percutaneous Endoscopic Gastrostomy Tubes : Experience in Thai Children
Treepongkaruna S Mail, Pansrimangkom W , Pienvichit P , Kolkalkul J , Suthutvoravut U

Background : Percutaneous endoscopic gastrostomy (PEG) is a well-established alternative
to open gastrostomy for providing long-term enteral nutrition. Although the commercial PEG
tube is available and suitable for the procedure, its cost is relatively high for low socioeconomic
people. Therefore, modified PEG tubes have been used in our hospital.
Objectives : To evaluate the outcome and complications of PEG performed in children at
Ramathibodi Hospital and compare the results between the commercial PEG and modified PEG
tubes.
Method : All children who had PEG performed at Ramathibodi Hospital, from January 1999
to May 2002, were included in the study. The demographic data, indications for PEG, types of PEG
tube, outcomes and complications were retrospectively reviewed. The modified PEG tube was made
by connecting a Malecot four-wing catheter to the previously used, re-sterilized distal part of a
commercial PEG tube.
Results : PEG was performed on 34 children, aged 4 months to 13 years, and successfully
placed in 30 children (88.2% ). The commercial and modified PEG tubes were used in 20 cases and
10 cases, respectively. Early complications occurring in the first 7 days post-procedure were found
in 9 cases (30%) as follow: peritonitis (1 case), peristomal wound infection (7 cases), and subcutaneous
emphysema (1 case). Late complications occurring at more than 7 days post-procedure were
found in 15 cases (50%) and all were minor problems. There was no difference in complication rates
between the 2 types of PEG tubes.
Conclusion : PEG is safe even in small infants. Minor complications are common but can
be simply managed. The modified PEG tube is an alternative for a commercial PEG tube in an
unaffordable situation.
Key word : Percutaneous Endoscopic Gastrostomy, Enteral Nutrition

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