Objectives and Study

PEG feeding has become standard of care for a select group of chronically ill and often small children. Peri- and post-interventional complications of tube insertion are well described. Only limited data exist about the anaesthetic risks in adults but none in this specific paediatric cohort.

The aim of this study is the evaluation of complications and risk factors in paediatric anaesthesia for the PEG placement in our own center.

Methods

Patient case notes of all children receiving PEG insertion at our institution were analyzed. Included were all consecutive cases from February 2020 to April 2022. No exclusion criteria applied. All patients underwent the procedure as in-patient cases. Ethical approval for this retrospective analysis was granted by the ethical committee of the Hannover Medical School (10615_BO_K_2022).

Results

Thirty-one patients, aged 2 months to 17 years, have been identified. The underlying diagnosis for PEG placement was predominantly feeding difficulties due to various pediatric conditions. Weight ranged from 2.0 to 47.0 kg. Thirty-seven-point five percent of these patients were under the age of 1 year and 75.0% had an American Society of Anesthesiologist’s physical status classification (ASA) of III or higher. In 51.6% cases, pulmonary complications were detected.

Laryngospasm and bronchospasm occurred in 3.2% each with desaturation below 90 %. Ventilation problems with increased ventilation pressure > 10 points above the initial value and hypercapnia > 60 mmHg occurred in 35,5%. Fifty percent of the children with compromised oxygenation or ventilation were younger than one year of age.

Twelve-point nine percent of all patients needed mechanical ventilation post intervention and 19.4% had a newly occurred demand for oxygen supply.

Conclusions

Although considered a routine procedure with a good safety record, the PEG insertion can cause significant anaesthetic complications in children. Especially younger children and patients with a higher ASA are more likely to suffer severe pulmonary complications.

Objectives and Study

Adequate bowel preparation facilitates ileocolonoscopy completion. Pediatric Endoscopy Quality Improvement Network (PEnQuIN) quality standards recommend unadjusted rates of adequate bowel preparation of ≥ 80% and terminal ileal intubation ≥85%. A Boston Bowel Preparation Scale (BBPS) score of ≥6 is adequate.

This study aims to identify whether UK hospitals are attaining PEnQuIN standards, and reviews medications used.

Methods

Fifteen UK hospitals participated. Local governance processes were followed. Each hospital provided anonymous BBPS data.

Patients were grouped according to bowel preparation drug type. Patients were excluded if procedures were abandoned due to significant bleeding, stricture, previous resections or severe disease and if a subgroup had below 5 patients. A single factor Anova test and two sample T-Test was performed.

Results

Complete data for 209 patients from 12 hospitals was collated. Five of 12 participating hospitals attained the PEnQuIN standard for adequate bowel preparation.

Bowel preparation drugs varied greatly among hospitals. Patients were grouped according to drug type for analysis (see table 1).

Only Group C achieved the desired adequate bowel preparation rate of ≥ 80%. Not all groups are equal (p<0.006) on single factor Anova analysis. Significant differences in BBPS scores between groups A&C and B&C were found on a paired T test. Significant subgroup variability exists regarding drug timing, dosage and frequency resulting in heterogeneity.

Conclusions

This initial study highlighted marked variability in the UK use of bowel preparation medications. Only Group C attained the PEnQuIN standard for adequate bowel preparation. Groups A and B achieved high ileal intubation rates despite not meeting the standard. A large prospective multi-centred trial is required to establish the ideal medication type and protocol for bowel preparation in children.