Percutaneous endoscopic gastrostomy. New technique--old complications

Early reports support the percutaneous endoscopic gastrostomy (PEG) as an alternative to traditional gastrostomy with lower cost, greater ease of placement, and low morbidity and mortality. The authors' bias has been to attempt PEG on nearly all patients referred to gastrostomy tube prior to performing open gastrostomy. In this light, we reviewed our 32 month experience of 115 PEG placements in 112 adult patients, with a mean follow-up of 59.4 days. Placement was unsuccessful in ten per cent of patients and difficult in another six per cent. Minor postoperative complications not requiring intervention occurred in 9.5 per cent of patients, and major complications in 20 per cent. Infection was the most common postoperative problem. Thirty day mortality was 24 per cent. No patient died as a direct result of the procedure. The ten per cent failure rate is a consequence of attempting PEG as the initial procedure in greater than 90 per cent of patients. PEG can be employed as an initial procedure in even the sickest of patients with a high rate of success, and morbidity comparable to open gastrostomy. This knowledge allows early PEG placement in all types of patients, thereby facilitating their transfer to a non-acute care environment.