EXPERIENCES WITH PERCUTANEOUS ENDOSCOPIC GASTROSTOMY

Today the procedure of choice for long-term enteral tube feeding in pa tients with prolonged swallowing difficulties or inabilities is percut aneous endoscopic gastrostomy (PEG). The primary indications are head and neck cancers, neurologic dysphagia, cancer cachexia, and obstructi on of the esophagus and pharynx with enough space for an endoscopic pr ocedure, This technique requires no general anesthesia and is possible in patients with contraindications to surgical gastrostomy. Between S eptember 1994 and April 1995 a total of 115 patients underwent PEG pla cement attempts. We employed the pull-technique with 15-Freka PEC tube s, The average procedure time, including esophagogastroduodenoscopy, w as 17 minutes. In nine cases PEC insertion was impossible owing to sev ere obstruction of the esophagus. In 46 (40%) patients local abdominal pains started on the first or second postoperative day; 7 of these pa tients required surgical consultation, and no Further intervention was needed, In only one patient was there a serious complication that req uired surgical intervention: a presumed perforation that turned out to have no correlate upon review All patients received single-shot antib iotic prophylaxis; and only in those patients with abdominal symptoms do we recommend a prolonged antibiosis. The abdominal symptoms reporte d were due to a slight leak of gastric fluid causing a topical periton itis, which required no further treatment. In our experience PEG is a useful alternative to surgical gastrostomy. The simplicity of this pro cedure leads to low complication rates, short hospitalization, and is possible on an outpatient basis. It is cost-efficient and has a much b etter psychological tolerance than nasogastric tubes.