Percutaneous endoscopic gastrostomy as a minimally invasive and most effective method of long-term nutritional support in children with cancer (single-center study)

Background. Nutritional support (NS) in children suffering from cancer and underweight is an important aspect of maintaining the growth and development of the child. The optimal method of short-term NS is endoscopically-assisted installation of a nasointestinal tube. Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive surgical procedure for children who require long-term NS. Unlike the installation of a nasointestinal tube and the laparoscopic method of gastrostomy installation, PEG is characterized by a lower number of complications, ease and speed of installation and removal of gastrostomies, as well as better social adaptation of patients due to ease of care.

Purpose of the study – to present the experience of performing PEG and installing a nasointestinal tube for NS and the range of complications of PEG and tubes in children with cancer based on the experience of the N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia.

Materials and methods. In a retrospective study conducted at the N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia in the period from January to December 2022, the results of endoscopic diagnosis and treatment of 38 (100 %) children with cancer requiring long-term NS were analyzed. The first group included patients (n = 16; 40.1 %) requiring long-term NS (> 6 weeks), the second (n = 22; 59.9 %) – short-term NS (< 6 weeks). At the first stage, all patients underwent esophagogastroduodenoscopy to determine the possibility and method of performing PEG in the first group of patients and to install a nasogastric or nasojejunal tube in patients in the second group. At the second stage, patients from the first group underwent PEG using methods PULL and PUSH (in Russell modification).

Results. The first group of the study consisted of patients with cancer (n = 13; 34.2 %), aged from 4 months to 17 years (median age – 8.5 years), who underwent PEG PUSH (in Russell modification) (n = 8; 61.5 %) and PULL methods (n = 5; 38.5 %). In three patients, PEG was associated with a high risk of complications – obstruction of the gastric outlet with the intragastric part of the gastrostomy, perforation of the liver and colon, and therefore the patients underwent endoscopically-assisted installation of nasojejunal tubes. The main indications for PEG were: the need for long-term (> 6 weeks) NS (n = 13; 34.2 %) and the inability to feed independently (n = 13; 34.2 %). There was no correlation between the localization of the primary tumor focus and the PEG method (p > 0.05) (n = 13; 34.2 %). In 5.3 % of cases (n = 2), the installation of a gastrostomy tube was preceded by long-term (> 42 days) functioning of a nasointestinal tube. There were no developments of intra- and postoperative complications (median follow-up – 60 days) in the group of patients who underwent PEG (n = 13; 34.2 %). The second group of the study consisted of patients (n = 25; 65.8 %), in whom in 100 % of cases a nasointestinal tube was installed for NS for 7–30 days (average duration was 18.5 days), of which in 45. In 4 % of cases, complications such as migration of the probe into the lumen of the stomach (n = 4; 18.2 %), erosive and ulcerative changes with the formation of bedsores of the mucous membrane of the esophagus (n = 3; 13.6 %), stomach (n = 2; 9.1 %) and duodenum (n = 1; 4.5 %).

Conclusion. Enteral tube feeding is a safe and effective method of short-term NS for pediatric cancer patients, however, it may be associated with aesthetic discomfort, spontaneous removal of the tube, and a number of complications. PEG is the method of choice when long-term NS is required for patients under 18 years of age, characterized by minimal invasiveness and safety of the intervention, as well as ease of care, replacement and removal of gastrostomy tubes.

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