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PERCUTANEOUS ENDOSCOPIC GASTROSTOMY INSERTION IN CHILDREN

(PEM - PROTEIN-ENERGY MALNUTRITION)
Percutaneous Endoscopic Gastrostomy Insertion in Children

WHAT YOU NEED TO KNOW:

What do I need to know about percutaneous endoscopic gastrostomy insertion? Percutaneous endoscopic gastrostomy (PEG) insertion is a procedure to place a soft, plastic feeding tube into your child's stomach. Your child may need a PEG tube if he cannot get enough nutrition by eating his food. Liquid food can be given through the tube to give your child's body the nutrition it needs. The tube may also be used to remove air and fluid from your child's stomach.


How do I help my child prepare for the procedure? Your child's healthcare provider will talk to you about how he should prepare for the procedure. He may tell you that your child should not eat or drink anything after midnight on the day of his procedure. He will tell you what medicines your child can take on the day of the procedure.

What will happen during the procedure?

  • Your child's surgeon will give him medicine to help him relax and make him drowsy. The surgeon will insert the endoscope through your child's mouth, down his esophagus, and into his stomach. The light on the end of the endoscope may be seen through your child's abdomen. The light will help the surgeon find the best place to insert the PEG tube. He may inject air into your child's stomach so he can see clearly.

  • Local anesthesia may be given as a shot to numb an area on your child's stomach. The surgeon will make a small incision in your child's abdomen and insert a catheter with a wire through the opening and into his stomach. The wire will be guided up through the endoscope and into your child's mouth. The PEG tube will be attached to the wire and pulled down into your child's stomach. The surgeon will bring one end of the PEG tube out through the opening in your child's abdomen. The other end of the PEG will stay in your child's stomach and will be held in place with a piece of plastic or small inflated balloon. This will prevent it from coming out through the opening in his abdomen (stoma).

  • Once your child's surgeon is sure the PEG tube is in the right place, the endoscope and wire will be removed. If his surgeon cannot use an endoscope, a PEG tube will be directly inserted into your child's stomach through the incision on his abdomen. The surgeon will use an ultrasound to find the right place to put the PEG tube in your child's stomach.

What are the risks of the procedure?

  • The endoscope may cause damage or bleeding in your child's esophagus, stomach, or abdomen. During or after the procedure, liquid from your child's stomach may get into his lungs and cause an infection. Your child's stoma and skin around it may be bruised and painful. Sores may form in the skin around his stoma, and tissue may grow over the PEG tube.

  • The end of the PEG tube in your child's stomach may move out of place. The PEG tube may become blocked and it may crack, break, or leak. Your child's stomach may not empty into his intestines correctly. A fistula (abnormal tissue opening) may form between your child's skin and stomach or intestines. The stoma may become infected. The infection may spread to other areas of your child's body and become life-threatening.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.