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UEG Standards and Guidelines

Position Paper

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Abstract

Background

The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper from 2015 on percutaneous endoscopic gastrostomy (PEG) required updating in the light of recent clinical knowledge and data published in medical journals since 2014.

Methods

A systematic review of medical literature from 2014 to 2020 was carried out. Consensus on the content of the manuscript, including recommendations, was achieved by the authors through electronic and virtual means. The expert opinion of the authors is also expressed in the manuscript when there was a lack of good scientific evidence regarding PEGs in children in the literature.

Results

The authors recommend that the indication for a PEG be individualized, and that the decision for PEG insertion is arrived at by a multidisciplinary team (MDT) having considered all appropriate circumstances. Well timed enteral nutrition is optimal to treat faltering growth to avoid complications of malnutrition and body composition. Timing, device choice and method of insertion is dependent on the local expertise and after due consideration with the MDT and family. Major complications such as inadvertent bowel perforation should be avoided by attention to good technique and by ensuring the appropriate experience of the operating team. Feeding can be initiated as early as 3 hours after tube placement in a stable child with iso-osmolar feeds of standard polymeric formula. Low-profile devices can be inserted initially using the single-stage procedure or after 2–3 months by replacing a standard PEG tube, in those requiring longer-term feeding. Having had a period of non-use and reliance upon oral intake for growth and weight gain—typically 8–12 weeks—a PEG may then safely be removed after due consultation. In the event of non-closure of the fistula the most successful method for closing it, to date, has been a surgical procedure, but the Over-The-Scope-Clip (OTSC) has recently been used with considerable success in this scenario.

Conclusions

A multidisciplinary approach is mandatory for the best possible treatment of children with PEGs. Morbidity and mortality are minimized through team decisions on indications for insertion, adequate planning and preparation before the procedure, subsequent monitoring of patients, timing of the change to low-profile devices, management of any complications, and optimal timing of removal of the PEG.

Percutaneous Endoscopic Gastrostomy in Children

Matjaz Homan

Publisher

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Guideline

Position Paper

Topics

Paediatrics

Citation

Journal of Pediatric Gastroenterology and Nutrition, 73: 415-426

Published

2021

UEG Podcast Episode

Journal Podcast

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Autoimmune pancreatitis and inflammatory bowel disease

Iago Rodríguez-Lago 1, Miroslav Vujasinovic 2

1 Hospital Universitario de Galdakao, Bilbao, Spain

2 Karolinska University Hospital, Stockholm, Sweden

Topics

IBD

Published

2022

UEG Podcast Episode

UEG Podcast

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Best of UEG Week - Endoscopy with Manmeet Matharoo

Manmeet Matharoo, Egle Dieninyte - Misiune

Topics

Endoscopy

Published

2025

UEG Podcast Episode

UEG Podcast

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Raising pancreatic superstars: from mice to knives

Egle Dieninyte - Misiune 1, Johanna Laukkarinen 2, Alberto Balduzzi 3

1 Center of hepatology, gastroenterology and dietetics, Vilnius university Santaros Klinikos, Lithuania

2 Tampere University Hospital, Tampere, Finland

3 Hospital P. Pederzoli, Peschiera del Garda, Verona, Italy

Topics

Pancreas

Published

2024

UEG Presentation

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Panel discussion: Liver and pregnancy - Beware of dangerous liaisons

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Hepatobiliary Paediatrics

Session

Liver and pregnancy: Beware of dangerous liaisons

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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MAGNETIC RESONANCE IMAGING (MRI) SHOWS CHANGES IN BOWEL MORPHOLOGY AND MOTILITY IN SHORT BOWEL SYNDROME WITH INTESTINAL FAILURE (SBS-IF) AND COLON-IN-CONTINUITY (CIC) AFTER TREATMENT WITH THE LONG-ACTING GLUCAGON-LIKE PEPTIDE-2 (GLP-2) ANALOG APRAGLUTIDE

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Introduction

SBS-IF is a severe organ failure with long-term parenteral support (PS) dependence. In the first years after extensive surgery, spontaneous structural (elongation of intestinal villi and crypts) and functional (incl. motility) intestinal changes occur, stimulating a more efficient nutrient and fluid absorption in the remnant bowel. GLP-2 analogs are hypothesized to boost intestinal adaptation resulting in increased intestinal absorption and reduced PS needs. Apraglutide (APRA) is a long-acting GLP-2 analog in development for SBS-IF. We investigated the effect of APRA at 52 weeks (W) on bowel morphology and motility based on magnetic resonance imaging (MRI).

Aims & Methods

STARS Nutrition is a 52-W multicenter, open-label, phase 2 study in adult SBS-IF-CiC pts receiving weekly subcutaneous APRA injections (5mg). We hypothesized that APRA treatment would lead to thickening of the intestinal mucosa, intestinal lengthening, reduced bowel dilatation and reduced intestinal motility. Therefore, MRI scans of the abdomen, incl. cine sequences, after oral intake of a mannitol solution (600mL) were performed at baseline and at 4W, 24W and 48W of treatment. Morphology parameters were measured on static MRI sequences; GI Quant software was used to quantify motility on cine MRI sequences. Data are presented as median (IQR). Nominal p-values are calculated using Wilcoxon matched-pairs signed rank tests with significance set at 0.05.

Results

Nine pts were included and comprise the full study population. While the numerically increased colon length failed to reach significance, small bowel length increased significantly from 29.7 to 40.7 cm (p=0.012) at 48W. Duodenal wall thickness increased by 0.8 (0.2;1.2) mm (p=0.020). There were no diameter changes in the small bowel nor colon. Changes in motility were evaluated using data from 7 pts, due to missing data. Over time, small bowel motility gradually reduced, albeit not significant. Motility in the proximal colon was significantly reduced at 48W. In the distal colon, decreased motility was observed at 4W and 24W, but returned to baseline level at 48W.

Conclusion

Using static and cine MRI sequences in pts with SBS-IF-CIC, STARS Nutrition shows that APRA treatment was associated with small bowel lengthening and increased duodenal wall thickness suggesting an intestinotrophic effect. Both effects may contribute to an increased surface area for absorption. The reduced motility, especially in the proximal colon may reduce transit time, allowing more time for absorption of nutrients, fluids and electrolytes; and reduced fecal output. Whether bowel lengthening results from a direct effect of APRA vs. changes in motility with passive elongation is subject of further investigation.

Disclosure

Astrid Verbiest, Mark Krogh Hvistendahl, Ragna Vanslembrouck, Ronald Peeters, Riccardo Sartoris – nothing to declare.
Palle Bekker Jeppesen – received grants/research support/honoraria or consultation fees from Agomab, Albumedix A/S, ArTara Therapeutics, Bainan Biotech, Baxter, Coloplast, Ferring, Fresenius Kabi, GLyPharma, Naia Pharma, NPS Pharmaceuticals, NorthSea Therapeutics, Shire, Takeda, The Novo Nordisk Foundation, Therachon, VectivBio and Zealand Pharma.
Francisca Joly – has received grants/research support/honoraria or consultation fees from Agomab, Baxter, Fresenius Kabi, Nestlé Health Sciences, BBraun, Theradial, Mayoli, Biocodex, mobile3e Consulting, Carembouche, NPS Pharmaceuticals, NorthSea Therapeutics, Shire, Takeda, Therachon, VectivBio and Zealand Pharma.
Tim Vanuytsel – has served on the speaker bureau for Abbott, Agomab, Baxter, Biocodex, Dr. Falk Pharma, Fresenius Kabi, Ipsen, Menarini, Microbiotica, MyHealth, Remedus, Takeda, Truvion, VectivBio and Zealand Pharma. TV has provided clinical advice to Baxter, Danone, Dr. Falk Pharma, MyHealth, NorthSea Therapeutics, Shire, Therachon, Takeda, VectivBio, Zealand Pharma. TV has received research grants from Danone, MyHealth, Takeda and VectivBio.
Federico Bolognani, Carrie Li and Nader N. Youssef – employees of VectivBio/Ironwood.

This research was supported by VectivBio AG/Ironwood.