PEG: EMBRACED BY FAMILIES, A USEFUL TOOL IN THE NUTRITIONAL MANAGEMENT OF EARLY CHILDHOOD CHOLESTASIS.

Griffiths, E.; Tremlett K.; Jayaprakash K.

PEG: EMBRACED BY FAMILIES, A USEFUL TOOL IN THE NUTRITIONAL MANAGEMENT OF EARLY CHILDHOOD CHOLESTASIS.

All Authors

Griffiths, E.

Tremlett K.

Jayaprakash K.

LTHT Author

Griffiths, Elizabeth
Tremlett, Kirsten
Jayaprakash, Kavitha

LTHT Department

Leeds Children's Hospital
Children's Liver Unit

Non Medic

Dietitian

Publication Date

2024

Item Type

Conference Abstract

Abstract

Nutrition is a key part of the management of chronic liver disease and supplemental feeds are often required in young children with significant cholestasis. Whilst the insertion and use of gastrostomies in the management of children requiring long term Nasogastric (NG) feeds in other fields of paediatrics is well established, historically units been reluctant to utilise them in children with chronic liver disease due to insertion challenges and potential complications, concerns of development of varices at gastrostomy site and interference with transplant surgery.1 2 We show that percutaneous endoscopic gastrostomy (PEG) insertion can be a useful tool, in the right cohort, of children with cholestatic liver disease and can have a significant positive impact on the wellbeing of the child and family. Since 2013 15 children managed in our specialist liver unit with (non-biliary atresia) cholestatic chronic liver disease have required supplemental, non-oral feeds as part of their nutritional management in early childhood. See table 1 for breakdown of diagnosis. All required supplemental feeding before 6 years of age due to fat malabsorption, poor growth and parental difficulties in managing the child's dietary needs orally. 8 of these children received a PEG and one further child is awaiting PEG insertion. Of these 7 were established on NG feeds prior to PEG insertion, one child progressed straight to PEG insertion. 3 patients progressed rapidly to PEG insertion due to frequent loss of NG tube due to pruritis. 8 of 15 have received a liver transplant, of which 3 had a PEG in situ at the time of transplant, one of whom required resiting at the time of transplant. None had a portal hypertension at the time of PEG insertion, however 2 developed portal hypertension at a later date, prior to transplantation. Neither developed varices at the PEG site. One child who underwent a PEG insertion shortly after commencing NG feeding was able to transition back to full oral feeding in the years following transplant. One child died two years after PEG insertion from an unrelated condition. There were no significant complications of PEG insertion in this cohort. Although there was no significant change in nutritional or growth parameters in these children, pre and post PEG nor compared to those who did not undergo PEG insertion, families report a significant improvement in the quality of life of both themselves and their child, most strongly seen in those for whom frequent repassage of NG tubes were causing distress. Those who have required long-term NG feeds display ongoing behavioural feeding difficulties even post transplantation. As a result of these experiences, we are moving increasingly towards early PEG insertion in select patients. In conclusion, gastrostomies have a key role in the nutritional management of early childhood cholestasis and early insertion should be considered in those requiring long term NG feeds, particularly when oral aversion has developed after NG insertion, or when frequent tube insertions are required. (Table Presented).